A new technique for intraoperative continuous biliary drainage during pancreatoduodenectomy.
BACKGROUND
The common hepatic duct is divided during the early stage of pancreatoduodenectomy. Complete and prolonged closure of the proximal common duct stump can cause liver damage in the course of this long operation, resulting in associated complications.


METHODS
We performed intraoperative continuous external bile drainage by a new method using a novel drainage clamp in 47 consecutive patients (drainage clamp group) and compared postoperative liver enzyme levels, inflammation markers, morbidity, and outcomes with those of a conventional clamp group (n = 40).


RESULTS
The drainage clamp group had significantly lower transaminase levels within the first 14 postoperative days than the conventional clamp group. The number of patients with elevated transaminase was significantly less in drainage clamp group than conventional clamp group (p < 0.001). There were no significant differences between these two groups in terms of mortality rates and postoperative morbidity.


CONCLUSIONS
Intraoperative complete closure of the common hepatic duct contributed to postoperative elevated transaminase levels, and the continuous decompression of the hepatic duct during pancreatoduodenectomy is beneficial to patients by avoiding liver dysfunction. The novel drainage clamp is a safe and useful tool for pancreatoduodenectomy and other operative procedure where extrahepatic bile duct is dissected.
Doi
Ryuichiro
R
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kyoto University, Kyoto, Japan. doir@kuhp.kyoto-u.ac.jp
Kami
Kazuhiro
K
Kida
Atsushi
A
Nagai
Kazuyuki
K
Ogawa
Kohei
K
Kawaguchi
Yoshiya
Y
Egawa
Hiroto
H
Uemoto
Shinji
S
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D017734:Bile Ducts, Extrahepatic; D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013525:Surgical Instruments
D002097:C-Reactive Protein; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin