title: A novel technique for reducing pancreatic fistulas after pancreaticojejunostomy.
abstract: Risk factors for anastomotic leaks of pancreaticojejunostomy have been well described. We present a technique using indocyanine green dye (ICG) and a near-infrared (NIR) capable laparoscope to assess blood supply to the transected margin of the pancreas before pancreaticojejunal anastomosis. A 39-year-old female patient underwent a laparoscopic-assisted pancreaticoduodenectomy (Whipple's procedure) for an invasive ampullary adenocarcinoma. Before construction of the pancreaticojejunal anastomosis, the viability of the margin of the remnant pancreas was assessed with infrared scanning of injected ICG. The NIR identified an ischaemic segment of the margin, which was further resected. The patient had no postoperative evidence of a pancreatic leak and was discharged home on postoperative day 18. Ischaemia of the remnant pancreas is a risk factor for pancreaticojejunostomy leak. Infrared ICG testing might help to identify these ischaemic segments, which can be excised before anastomosis, and reduce failure rates.
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France Department of General and HPB Surgery, Royal Blackburn Hospital, Lancashire, UK.
authors.forename: Daren
authors.initials: D
authors.lastname: Subar
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pietrasz
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France brice.gayet@imm.fr.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet