Tag Archives: pancreatic fistula

Cephalic Duodeno-Pancreatectomy With Pancreatic-Gastric Anastomosis With Double Purse String, in Patient with Lithiasis and Tumoral Jaundice – Case Report

Tudor A, Molnar C, Nicolescu C, Rosca C, Tudor Bianca, Butiurca VO, Copotoiu C

University of Medicine and Pharmacy Tirgu-Mures

DOI: 10.2478/amma-2014-0047

Introduction: One of the most feared complications after cephalic duodeno-pancreatectomy remains pancreatic fistula. In recent years, various methods of pancreatico-digestive reconstruction were performed in order to reduce the rate of pancreatic fistula. One of these methods is pancreatico-gastric reconstruction by using two purse string threads.
Case report: We present in this article a patient with jaundice with mixed etiology: tumoral and lithiasic. Subjectively, the patient accused sclerose-skin-jaundice, right upper quadrant and epigastric pain, nausea and vomiting. Computed tomography revealed dilatation of intra- and extrahepatic bile ducts, a dilated Wirsung duct and a tumor at the biliopancreatic confluence, leading to a suspicion of vaterian ampulom. Upper endoscopy revealed a tumor protruding in the descending duodenal segment. Intraoperatively a tumor suggestive of vaterian ampulom and duct stones was shown. Surgical treatment consisted of coledocolitotomy, cephalic duodeno-pancreatectomy with pancreatic-gastric anastomosis, performed by using two purse string threads. The postoperative evolution was favorable.
Conclusion: Pancreatico-gastric anastomosis using two purse string threads is a simple, safe and quick procedure, avoiding the application of sutures through the pancreatic parenchyma and thus reducing the rate of pancreatic fistula.

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Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

Tudor A1,2, Butiurca VO2*, Nicolescu C1,2, Bianca Tudor1, Simona Gurzu1, Molnar C1, Copotoiu C1

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Mureș County, Romania

DOI: 10.1515/amma-2015-0058

Introduction. Although in recent years there have been various versions of pancreatic – digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.
Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.
Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico – digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ducto-mucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).
Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.
Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

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Pancreatico-Gastric Anastomosis with and without Sutures: Experimental Swine Model

Tudor A1, Molnar C2*, Copotoiu C2, Butiurca VO3, Nicolescu C1, Tudor Bianca4, Gurzu Simona5

1 M1 Departament, University of Medicine and Pharmacy Târgu-Mureș, Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Romania
2 M5 Department, University of Medicine and Pharmacy Târgu-Mureș, Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Romania
3 Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Romania
4 M2 Department, University of Medicine and Pharmacy Târgu-Mureș, Central Laboratory of Târgu-Mureș Emergency County Hospital, Romania
5 M1 Department, University of Medicine and Pharmacy Târgu-Mureș, Târgu-Mureș Emergency County Hospital, Romania

DOI: 10.1515/amma-2015-0032

Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches.
Methods. Our experimental model is based on ten piglets, which were divided into 2 groups.  In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas.
Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group. Conclusions.
In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

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