Research Article
PANKREATİKODUODENEKTOMİ PROSEDÜRÜNDE GASTROJEJUNUOSTOMİ ANASTOMOZUNUN SİRKÜLER STAPLER İLE YAPILMASI ÖNERİLEBİLİR Mİ?
Abstract
GİRİŞ:Pankreatikoduodenektomi, cerrahi deneyim gerektiren oldukça karmaşık bir işlemdir. İşlem sırasında gastrojejunostomi anastomozunun yapımında stapler kullanılması bunların arasında yer almaktadır. Çalışmamız elle ve sirküler stapler ile yapılan gastrojejunostomi anastomoz işlemlerinin hasta sonuçlarını karşılaştırmaktadır.
GEREÇ VE YÖNTEM: Çalışmamızda Mayıs 2015 ile Aralık 2019 tarihleri arasında aynı cerrahi ekip tarafından pankreatikoduodenektomi yapılan 44 hastanın verileri geriye dönük olarak değerlendirildi. Gastrojejunostomi anastomozu el ile yapılan hasta grubu ile (n=32) ve anastomozu stapler (25 nolu sirküler stapler) ile yapılan hasta grubu(n=12) anastomoz darlığı açısından araştırıldı.
BULGULAR:Pankreatikoduodenektomi yapılan 44 hastanın %68,2'si erkekti, yaş ortalaması 62,9±12,1 yıl ve ortalama takip süresi 28,2±21,2 aydı. Gastrojejunostomi darlığı oranı sirküler stapler grubunda anlamlı derecede yüksekti (p = 0,017;p < 0,05).
SONUÇ: : Pankreatikoduodenektomi prosedüründe gastrojejunostomi anastomozunun sirküler stapler ile yapılmasını, postoperatif pankreas fistülü ve anastomoz darlığı riskini yükseltmesi, ayrıca operasyon süresi açısından da avantaj sağlamaması nedeniyle önermemekteyiz.
References
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- 11. Sakamoto Y., Hori S., Oguro S., Arita J., Kishi Y., Nara S., et al (2016). Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy: A Randomized Controlled trial. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 20(3), 595–603. https://doi.org/10.1007/s11605 015-2961-6
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- 17. Gould J. C., Garren M., Boll V., & Starling J. (2006). The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surgical Endoscopy, 20(7), 1017–20. https://doi.org/10.1007/s00464-005-0207-5
- 18. Nguyen N. T., Stevens C. M., & Wolfe B. M. (2003). Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 7(8), 997–1003; discussion 1003. https://doi.org/10.1016/j.gassur.2003.09.016
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Year 2024,
Volume: 63 Issue: 3, 356 - 361, 09.09.2024
Abstract
INTRODUCTION:Pancreaticoduodenectomy is a highly complex procedure that requires surgical experience.. Among these is the use of a stapler in the construction of the gastrojejunostomy anastomosis during the procedure. Our study compares the patient outcomes of gastrojejunostomy anastomosis procedures performed manually and with a circular stapler.
MATERIALS AND METHOD:Our study retrospectively evaluated the data of 44 patients who had undergone pancreaticoduodenectomy performed by the same surgical team between May 2015 and December 2019. The manual gastrojejunostomy anastomosis(n = 32) and stapled (circular stapler 25 millimeter) anastomosis(n=12) patient groups were compared for anastomotic stricture.
RESULTS:Of the 44 patients undergoing pancreaticoduodenectomy, 68.2% were male, the mean age was 62.9±12.1 years and the mean follow-up was 28.2±21.2 months. The rate of gastrojejunostomy stricture was significantly higher in the circular stapler group (p = 0.017;p < 0.05).
CONCLUSION:The increased risk of postoperative pancreatic fistula and anastomotic stricture prevents us from recommending the use of a circular-stapler in the creation of the gastrojejunostomy anastomosis in pancreaticoduodenectomy procedures, as it increases the risk of postoperative pancreatic fistula and anastomotic stricture, and provides no operative time advantage.
References
- 1. Karim S. A. M., Abdulla K. S., Abdulkarim Q. H., & Rahim F. H. (2018). The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study. International Journal of Surgery, 52, 383–7. https://doi.org/10.1016/j.ijsu.2018.01.041
- 2. Clancy T. E., & Ashley S. W. (2005). Pancreaticoduodenectomy (Whipple operation). Surgical Oncology Clinics of North America, 14(3), 533–52. https://doi.org/10.1016/j.soc.2005.05.006
- 3. Ball C. G., Pitt H. A., Kilbane M. E., Dixon E., Sutherland F. R., & Lillemoe K. D. (2010). Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy. HPB: The Official Journal of the International Hepato Pancreato Biliary Association, 12(7), 465–71. https://doi.org/10.1111/j.1477 2574.2010.00209.x
- 4. Pecorelli N., Balzano G., Capretti G., Zerbi A., Di Carlo V., & Braga M. (2012). Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 16(3), 518–23. https://doi.org/10.1007/s11605-011-1777-2
- 5. Sato N., Yabuki K., Kohi S., Mori Y., Minagawa N., Tamura T., et al (2013). Stapled gastro/duodenojejunostomy shortens reconstruction time during pylorus-preserving pancreaticoduodenectomy. World Journal of Gastroenterology, 19(48), 9399–404. https://doi.org/10.3748/wjg.v19.i48.9399 6. Bassi C., Marchegiani G., Dervenis C., Sarr M., Abu Hilal M., Adham M., et al. International Study Group on Pancreatic Surgery (ISGPS). (2017). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 161(3), 584–91. https://doi.org/10.1016/j.surg.2016.11.014
- 7. Nomura S., Sasako M., Katai H., Sano T., & Maruyama K. (2000). Decreasing complication rates with stapled esophagojejunostomy following a learning curve. Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 3(2), 97–101. https://doi.org/10.1007/pl00011703
- 8. Hansen O., Schwenk W., Hucke H. P., & Stock W. (1996). Colorectal stapled anastomoses. Experiences and results. Diseases of the Colon and Rectum, 39(1), 30–6. https://doi.org/10.1007/BF02048265
- 9. Sakamoto Y., Kajiwara T., Esaki M., Shimada K., Nara S., & Kosuge T. (2009). Roux-en-Y reconstruction using staplers during pancreaticoduodenectomy: Results of a prospective preliminary study. Surgery Today, 39(1), 32–7. https://doi.org/10.1007/s00595-008-3814-7
- 10. Sakamoto Y., Yamamoto Y., Hata S., Nara S., Esaki M., Sano T., et al. (2011). Analysis of risk factors for delayed gastric emptying (DGE) after 387 pancreaticoduodenectomies with usage of 70 stapled reconstructions. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 15(10), 1789–97. https://doi.org/10.1007/s11605-011-1498-6 Versus
- 11. Sakamoto Y., Hori S., Oguro S., Arita J., Kishi Y., Nara S., et al (2016). Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy: A Randomized Controlled trial. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 20(3), 595–603. https://doi.org/10.1007/s11605 015-2961-6
- 12. Hajibandeh S., Hajibandeh S., Khan R. M. A., Malik S., Mansour M., Kausar A., et al. (2017). Stapled anastomosis versus hand-sewn anastomosis of gastro/duodenojejunostomy in pancreaticoduodenectomy: A systematic review and meta-analysis. International Journal of Surgery (London, England), 48, 1–8. https://doi.org/10.1016/j.ijsu.2017.09.071
- 13. Markar S. R., Penna M., Venkat-Ramen V., Karthikesalingam A., & Hashemi M. (2012). Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 8(2), 230–35. https://doi.org/10.1016/j.soard.2011.03.016
- 14. Fakas S., Elias M., Lim D., & Meytes V. (2021). Comparison of gastrojejunostomy techniques and anastomotic complications: A systematic literature review. Surgical Endoscopy, 35(12), 6489–96. https://doi.org/10.1007/s00464-020-08142-x
- 15. Jiang H.-P., Lin L.-L., Jiang X., & Qiao H.-Q. (2016). Meta-analysis of hand-sewn versus mechanical gastrojejunal anastomosis during laparoscopic Roux-en-Y gastric bypass for morbid obesity. International Journal of Surgery (London, England), 32, 150–7. https://doi.org/10.1016/j.ijsu.2016.04.024
- 16. Gonzalez R., Lin E., Venkatesh K. R., Bowers S. P., & Smith C. D. (2003). Gastrojejunostomy during laparoscopic gastric bypass: Analysis of 3 techniques. Archives of Surgery (Chicago, Ill.: 1960), 138(2), 181 4. https://doi.org/10.1001/archsurg.138.2.181
- 17. Gould J. C., Garren M., Boll V., & Starling J. (2006). The impact of circular stapler diameter on the incidence of gastrojejunostomy stenosis and weight loss following laparoscopic Roux-en-Y gastric bypass. Surgical Endoscopy, 20(7), 1017–20. https://doi.org/10.1007/s00464-005-0207-5
- 18. Nguyen N. T., Stevens C. M., & Wolfe B. M. (2003). Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 7(8), 997–1003; discussion 1003. https://doi.org/10.1016/j.gassur.2003.09.016
- 19. Shnell M., Nevo N., Lahat G., Abu-Abeid S., Goldstein A. L., Fishman S., et al (2021). Endoscopic Management of Sleeve Stenosis. Obesity Surgery, 31(11), 4749–53. https://doi.org/10.1007/s11695-021 05613-5
There are 18 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | General Surgery |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 9, 2024 |
| Submission Date | October 4, 2023 |
| Published in Issue | Year 2024Volume: 63 Issue: 3 |
