• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (1)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Quality of Care  • Quality of Care, Other  • Surgery  • Surgical Interventions  • Endocrine Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

Toshiyuki Moriya, MD; Clancy J. Clark, MD; Yujiro Kirihara, MD; Michael L. Kendrick, MD; Kaye M. Reid Lombardo, MD; Florencia G. Que, MD; Michael B. Farnell, MD

Arch Surg. 2012;147(1):35-40. doi:10.1001/archsurg.2011.850

Objective  To evaluate the efficacy of transanastomotic pancreatic duct internal stenting in the reduction of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.

Design  Retrospective study.

Setting  Mayo Clinic.

Patients  Between January 1, 1999, and September 30, 2010, 553 patients underwent pancreaticoduodenectomy by a single surgeon.

Main Outcome Measures  Rates of POPF, morbidity, and mortality between stent and no-stent groups.

Results  The clinically relevant POPF (International Study Group on Pancreatic Fistula definition grade B or C) rates in the stent and no-stent groups were similar (9.6% [43 of 449 patients] and 12.5% [13 of 104 patients], respectively; P = .38). Postoperative outcomes and morbidity were also similar between the 2 groups. Mortality was 0.7% (3 of 449 patients) for the stent group and 1.0% (1 of 104 patients) for the no-stent group. Four patients (0.9%) required endoscopic retrieval of the anastomotic stent. In subset analysis, the clinically relevant POPF rates in patients with a small pancreatic duct (3 mm; n = 167) were similar in the stent and no-stent groups (17.7% [23 of 130 patients] and 24.3% [9 of 37 patients], respectively; P = .38). In patients with a soft pancreatic gland (n = 64), rates of clinically relevant pancreatic fistulae were also similar in the stent and no-stent groups (31.7% [13 of 41 patients] and 17.4% [4 of 23 patients], respectively; P = .20).

Conclusions  Internal transanastomotic pancreatic duct stenting does not decrease the frequency or severity of POPF. The effect of stenting on long-term anastomotic patency warrants further investigation.

Author Affiliations: Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

The Right Way to Do a Whipple Procedure: Comment on "Stenting and the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy"
David C. Linehan
Arch Surg. 2012;147(1):41.
EXTRACT | FULL TEXT