title: Toward zero pancreatic leakage after pancreaticoduodenectomy for soft pancreas in low-volume pancreatic surgery centers.
abstract: Pancreatic leakage continues to occur after pancreaticoduodenectomy (PD) and it is a serious problem. It has been proposed that a normal-sized, soft, friable, and functionally normal pancreas with a thin-walled main pancreatic duct is at a greater risk of anastomotic leakage. However, despite the evaluation of various improvised procedures, pancreatic leakage persists as a complication. Here, we describe our PD technique that facilitates the prevention of pancreatic leakage. Our operative procedures includes 3 stages: pancreaticogastrostomy (PG), external and continuous suction drainage of pancreatic juice, and wrapping of the pancreatic anastomosis by using round ligament and applying fibrin glue sealant to the surface of the pancreatic anastomosis. Twenty-six patients with periampullary malignancy with soft pancreas underwent PG without any pancreatic leakage or fistula. The combined procedures, including PG, total external drainage with continuous suction of the pancreatic juice, and wrapping of the pancreatic anastomotic site by using round ligament is a useful method to prevent pancreatic leakage for cases of soft pancreas in pancreatic centers that do not encounter many such cases.
authors.affiliation: Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan. ooida.takatsugu@yokochu.jp
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Oida
authors.forename: Kenji
authors.initials: K
authors.lastname: Mimastu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kuboi
authors.forename: Hisao
authors.initials: H
authors.lastname: Kano
authors.forename: Sadao
authors.initials: S
authors.lastname: Amano
mesh_terms: D000368:Aged; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010193:Pancreaticojejunostomy; D012189:Retrospective Studies; D016896:Treatment Outcome