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首页> 中文期刊> 《国际肝胆胰疾病杂志（英文版）》 >Matched-pair analysis of postoperative morbidity and mortality for pancreaticogastrostomy and pancreaticojejunostomy using mattress sutures in soft pancreatic tissue remnants

Matched-pair analysis of postoperative morbidity and mortality for pancreaticogastrostomy and pancreaticojejunostomy using mattress sutures in soft pancreatic tissue remnants

         
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摘要

BACKGROUND: After pancreaticoduodenectomy, the incidence of postoperative pancreatic fistula remains high, especially in patients   with   "soft"   pancreatic   tissue   remnants.   No  "gold standard" surgical technique for pancreaticoenteric anastomosis has  been  established.  This  study  aimed  to  compare  the postoperative  morbidity  and  mortality  of  pancreaticogastro-stomy and pancreaticojejunostomy for "soft" pancreatic tissue remnants using modified mattress sutures. METHODS: Seventy-five patients who had undergone pancreatico-gastrostomy and 75 who had undergone pancreaticojejunostomy after  pancreaticoduodenectomy  between  2002  and  2008 were retrospectively compared using matched-pair analysis. A  modified  mattress  suture  technique  was  used  for  the pancreaticoenteric anastomosis. Patients with an  underlying "hard" pancreatic tissue remnant, as in chronic pancreatitis, were  excluded.  Both  groups  were  homogeneous  for  age, gender,  and  underlying  disease.  Postoperative  morbidity, mortality, and preoperative and operative data were analyzed. RESULTS: There were no significant differences between the groups  for  the  incidence  of  postoperative  pancreatic  fistula (10.7%  in  both).  Postoperative  morbidity  and  mortality, median  operation  time,  median  length  of  hospital  stay, intraoperative blood loss, and the amount of intraoperatively transfused erythrocyte concentrates also did not significantly differ  between  the  groups.  Patient  age  >65  years  (P=0.017), operation  time  >350  minutes  (P=0.001),  and  intraoperative transfusion  of  erythrocyte  concentrates  (P=0.038)  were identified as risk factors for postoperative morbidity. CONCLUSIONS: Our results showed no significant differences between  the  groups  in  the  pancreaticogastrostomy  and pancreaticojejunostomy  anastomosis  techniques  using mattress sutures for "soft" pancreatic tissue remnants. In our experience,  the  mattress  sutures  are  safe  and  simple  to  use, and pancreaticogastrostomy in particular is feasible and easy to learn, with good endoscopic accessibility to the anastomosis region.  However,  the  location  of  the  anastomosis  and  the surgical technique need to be individually evaluated to further reduce the incidence of postoperative pancreatic fistula.

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  • 来源
    《国际肝胆胰疾病杂志（英文版）》 |2012年第001期|89-95|共7页
  • 作者

    Fritz Klein; Marcus Bahra; Matthias Glanemann; Wladimir Faber; Peter Warnick; Andreas Andreou; Safak Gül; Dietmar Jacob;

  • 作者单位

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

    Department of General, Visceral, and Transplantation Surgery, Charité-Campus Virchow, Universitätsmedizin Berlin Klein F, Bahra M, Glanemann M, Faber W, Warnick P, Andreou A and Gül S, and Department of Visceral, Vascular, and Minimally Invasive Surgery, Vivantes Klinikum Spandau Jacob D, Berlin 13353, Germany;

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