Is circular-stapled gastrojejunostomy anastomosis apppropriate for pancreaticoduodenectomy?
Yıl 2024,
Cilt: 63 Sayı: 3, 356 - 361, 09.09.2024
Sevcan Alkan Kayaoğlu
,
Mehmet Ali Uzun
,
Doğan Erdoğan
Öz
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.
Kaynakça
-
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
PANKREATİKODUODENEKTOMİ PROSEDÜRÜNDE GASTROJEJUNUOSTOMİ ANASTOMOZUNUN SİRKÜLER STAPLER İLE YAPILMASI ÖNERİLEBİLİR Mİ?
Yıl 2024,
Cilt: 63 Sayı: 3, 356 - 361, 09.09.2024
Sevcan Alkan Kayaoğlu
,
Mehmet Ali Uzun
,
Doğan Erdoğan
Öz
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.
Kaynakça
-
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