title: Indications and results of pancreatic stump duct occlusion after duodenopancreatectomy.
abstract: Severe post-operative complications after pancreaticoduodenectomy (PD) are largely due to pancreatic fistula onset. The occlusion of the main pancreatic duct using synthetic glue may prevent these complications. Aim of this study is to describe this technique and to report short- and long-term results as well as the post-operative endocrine and exocrine insufficiency. Two hundred and four patients who underwent PD with occlusion of the main pancreatic duct in a period of 15 years were retrospectively analyzed. Post-operative complications and their management were the main aim of the study with particular focus on pancreatic fistula incidence and its treatment. At 1-year follow-up endocrine and exocrine functions were analyzed. We observed a 54 % pancreatic fistula incidence, most of which (77/204 patients) were a grade A fistula with little change in medical management. Twenty-eight patients developed a grade B fistula while only 2 % of patients (5/204) developed a grade C fistula. Nine patients required re-operation, 5 of whom had a post-operative grade C fistula. Post-operative mortality was 3.4 %. At 1-year follow-up, 31 % of patients developed a post-operative diabetes while exocrine insufficiency was encountered in 88 % of patients. The occlusion of the main pancreatic duct after PD can be considered a relatively safe and easy-to-perform procedure. It should be reserved to selected patients, especially in case of soft pancreatic texture and small pancreatic duct and in elderly patients with comorbidities, in whom pancreatic fistula-related complications could be life threatening.
authors.affiliation: Divisione di Chirurgia Digestiva, Fondazione Policlinico "A. Gemelli", Istituto di Clinica Chirurgica, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.affiliation: Divisione di Chirurgia Digestiva, Fondazione Policlinico "A. Gemelli", Istituto di Clinica Chirurgica, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quero
authors.affiliation: Divisione di Chirurgia Digestiva, Fondazione Policlinico "A. Gemelli", Istituto di Clinica Chirurgica, Rome, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rosa
authors.affiliation: Divisione di Chirurgia Digestiva, Fondazione Policlinico "A. Gemelli", Istituto di Clinica Chirurgica, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Di Miceli
authors.affiliation: Divisione di Chirurgia Digestiva, Fondazione Policlinico "A. Gemelli", Istituto di Clinica Chirurgica, Rome, Italy.
authors.forename: Antonio Pio
authors.initials: AP
authors.lastname: Tortorelli
authors.affiliation: Divisione di Chirurgia Digestiva, Fondazione Policlinico "A. Gemelli", Istituto di Clinica Chirurgica, Rome, Italy. giovanni.doglietto@unicatt.it.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Duodenopancreatectomy; Pancreas; Pancreatic fistula