BACKGROUND: Because survival after pancreaticoduodenectomy for cancer is limited, it is difficult to assess longterm pancreaticojejunal anastomotic patency. However, in patients with benign disease, pancreaticojejunal anastomotic stenosis may become problematic. What happens when pancreaticojejunal anastomosis revision is undertaken? METHODS: Patients undergoing pancreatic anastomotic revision after pancreatic head resection for benign disease between 1997 and 2007 at the Medical University of South Carolina were identified. A retrospective chart review and analysis were undertaken with the approval of the Institutional Review Board for the Evaluation of Human Subjects. Longterm follow-up was obtained by patient survey at a clinic visit or by telephone. RESULTS: During the study period, 237 patients underwent pancreatic head resection. Of these, 27 patients (17 women; median age 42 years) underwent revision of pancreaticojejunal anastomosis. Six patients (22%) had a pancreatic leak or abscess at the time of the index pancreatic head resection. The indication for revision of anastomosis was intractable pain. All patients underwent preoperative magnetic resonance cholangiopancreatography (MRCP), which indicated anastomotic stricture in 18 patients (63%). Nine other patients underwent exploration based on clinical suspicion caused by recurrent pancreatitis and stenosis was confirmed at the time of surgery. Six patients (22%) had perioperative complications after revision. The median length of stay was 12 days. There were no perioperative deaths; however, late mortality occurred in four patients (15%). Six of 23 survivors (26%) at the time of follow-up (median 56 months) reported longterm pain relief. CONCLUSIONS: Stricture of the pancreaticojejunal anastomosis after pancreatic head resection presents with recurrent pancreatitis and pancreatic pain. MRCP has good specificity in the diagnosis of anastomotic obstruction, but lacks sensitivity. Pancreaticojejunal revision is safe, but rarely effective, as a means of pain relief in patients with the pain syndrome associated with chronic pancreatitis.
BACKGROUND: Because survival after pancreaticoduodenectomy for cancer is limited, it is difficult to assess longterm pancreaticojejunal anastomotic patency. However, in patients with benign disease, pancreaticojejunal anastomotic stenosis may become problematic. What happens when pancreaticojejunal anastomosis revision is undertaken? METHODS:Patients undergoing pancreatic anastomotic revision after pancreatic head resection for benign disease between 1997 and 2007 at the Medical University of South Carolina were identified. A retrospective chart review and analysis were undertaken with the approval of the Institutional Review Board for the Evaluation of Human Subjects. Longterm follow-up was obtained by patient survey at a clinic visit or by telephone. RESULTS: During the study period, 237 patients underwent pancreatic head resection. Of these, 27 patients (17 women; median age 42 years) underwent revision of pancreaticojejunal anastomosis. Six patients (22%) had a pancreatic leak or abscess at the time of the index pancreatic head resection. The indication for revision of anastomosis was intractable pain. All patients underwent preoperative magnetic resonance cholangiopancreatography (MRCP), which indicated anastomotic stricture in 18 patients (63%). Nine other patients underwent exploration based on clinical suspicion caused by recurrent pancreatitis and stenosis was confirmed at the time of surgery. Six patients (22%) had perioperative complications after revision. The median length of stay was 12 days. There were no perioperative deaths; however, late mortality occurred in four patients (15%). Six of 23 survivors (26%) at the time of follow-up (median 56 months) reported longterm pain relief. CONCLUSIONS: Stricture of the pancreaticojejunal anastomosis after pancreatic head resection presents with recurrent pancreatitis and pancreatic pain. MRCP has good specificity in the diagnosis of anastomotic obstruction, but lacks sensitivity. Pancreaticojejunal revision is safe, but rarely effective, as a means of pain relief in patients with the pain syndrome associated with chronic pancreatitis.
Authors: Rainer W G Gruessner; David E R Sutherland; David L Dunn; John S Najarian; Tun Jie; Bernhard J Hering; Angelika C Gruessner Journal: J Am Coll Surg Date: 2004-04 Impact factor: 6.113
Authors: M Sho; Y Nakajima; H Kanehiro; M Hisanaga; K Nishio; M Nagao; Y Tatekawa; N Ikeda; H Kanokogi; T Yamada; S Hirohashi; R Hirohashi; H Uchida; H Nakano Journal: Am J Surg Date: 1998-09 Impact factor: 2.565
Authors: K D Lillemoe; G B Melton; J L Cameron; H A Pitt; K A Campbell; M A Talamini; P A Sauter; J Coleman; C J Yeo Journal: Ann Surg Date: 2000-09 Impact factor: 12.969
Authors: Steven M Strasberg; Jeffrey A Drebin; Nahush A Mokadam; Douglas W Green; Karen L Jones; Justis P Ehlers; David Linehan Journal: J Am Coll Surg Date: 2002-06 Impact factor: 6.113
Authors: Melena D Bellin; Andres Gelrud; Guillermo Arreaza-Rubin; Ty B Dunn; Abhinav Humar; Katherine A Morgan; Bashoo Naziruddin; Cristiana Rastellini; Michael R Rickels; Sarah J Schwarzenberg; Dana K Andersen Journal: Pancreas Date: 2014-11 Impact factor: 3.327
Authors: Alban Zarzavadjian Le Bian; Manuela Cesaretti; Nicolas Tabchouri; Philippe Wind; David Fuks Journal: J Gastrointest Surg Date: 2018-07-06 Impact factor: 3.452
Authors: Rachel E Simpson; Eugene P Ceppa; Howard H Wu; Fatih Akisik; Michael G House; Nicholas J Zyromski; Attila Nakeeb; Mohammad A Al-Haddad; John M DeWitt; Stuart Sherman; C Max Schmidt Journal: J Gastrointest Surg Date: 2019-01-02 Impact factor: 3.452