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- Title
Risk of pancreatic fistula after pancreatoduodenectomy – a point of view.
- Authors
Brătucu, Eugen; Daha, Claudiu; Simion, Laurenţiu
- Abstract
Cephalic pancreatoduodenectomy, a complex and difficult surgical procedure, has as main indication the radical treatment of pancreatic head cancers, but is also used in other periampullary tumors (neoplasms of the terminal choledochus, duodenal tumors, vaterian ampulloma, GIST). If the resection part of this procedure is well standardized, the reconstruction part has many variants, the most frequently used being the Whipple procedure, which involves restoring alimentary, bile and pancreatic transit in series on a jejunal loop. During the almost 100 years since this surgery has been practiced, the postoperative results have improved spectacularly, except for an increased incidence of pancreatic fistula, which can vary from 6% in centers of excellence to 30% in other centers. It is actually a complex, polluted, alimentary and biliary fistula, associated with high morbidity and mortality, reaching up to 26%. It is not the surgical technique but the quality of the pancreatic partner of this anastomosis that makes it being considered the “Achilles heel” of this operation. The authors, after evaluating various methods of pancreatic-digestive derivations, propose the way with elements of originality to achieve pancreatic-jejunal anastomosis (on isolated loop “à la Roux” axially drained uniquely, both biliary and pancreatic) that can decrease the incidence of fistula and diminish its severity, improving morbidity and mortality through this postoperative complication.
- Subjects
PANCREATIC fistula; PANCREATICODUODENECTOMY; PANCREATIC cancer; PANCREATIC surgery; SURGICAL complications; OPERATIVE surgery
- Publication
Oncolog-Hematolog, 2024, Issue 67, p47
- ISSN
2066-8716
- Publication type
Article