Cephalic Duodeno-Pancreatectomy with Pancreatic-Gastric Anastomosis with Double Purse String, in Patient with Lithiasis and Tumoral Jaundice - Case Report

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Abstract

Introduction: One of the most feared complications after cephalic duodeno-pancreatectomy remains pancreatic fistula. In recent years, various methods of pancreatico-digestive reconstruction were performed in order to reduce the rate of pancreatic fistula. One of these methods is pancreatico-gastric reconstruction by using two purse string threads.

Case report: We present in this article a patient with jaundice with mixed etiology: tumoral and lithiasic. Subjectively, the patient accused sclerose-skin-jaundice, right upper quadrant and epigastric pain, nausea and vomiting. Computed tomography revealed dilatation of intraand extrahepatic bile ducts, a dilated Wirsung duct and a tumor at the biliopancreatic confluence, leading to a suspicion of vaterian ampulom. Upper endoscopy revealed a tumor protruding in the descending duodenal segment. Intraoperatively a tumor suggestive of vaterian ampulom and duct stones was shown. Surgical treatment consisted of coledocolitotomy, cephalic duodeno-pancreatectomy with pancreatic-gastric anastomosis, performed by using two purse string threads. The postoperative evolution was favorable.

Conclusion: Pancreatico-gastric anastomosis using two purse string threads is a simple, safe and quick procedure, avoiding the application of sutures through the pancreatic parenchyma and thus reducing the rate of pancreatic fistula.

1. Reid-Lombardo KM, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg 2007;11:1451-1458.

2. Pratt WB, et al. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 2007;245:443-451.

3. Butturini G, et al. Complications after pancreaticoduodenectomy: the problem of current definitions. J Hepatobiliary Pancreat Surg 2006;13:207-211.

4. Deoliveira ML, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244: 931.

5. Yeo CJ, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580-592.

6. Duffas JP, et al. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 2005;189:720-729.

7. Bassi C, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 2005; 242:767.

8. Fernandez-Cruz, et al. Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 2008;248:930-938.

9. Aranha GV, et al. A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg 2003;7:672-682.

10. Adams, DB. The pancreatic anastomosis: the danger of a leak, which anastomotic technique is better? J Gastrointest Surg 2009;13:1182-1183.

11. Bassi C, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 2003; 134:766-771.

12. Berger AC., et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Amm Coll Surg 2009;208:738-747.

13. Cameron JL, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006; 244:10.

14. Waugh JM, Clagett OT. Resection of the duodenum and head of the pancreas for carcinoma; an analysis of thirty cases. Surgery 1946;20:224.

15. Ohigashi H., et al. A simple and safe anastomosis in pancreaticogastrostomy using mattress sutures. Am J Surg 2008;196:130-134.

16. Peng SY, et al. A pancreas suture-less type II binding pancreaticogastrostomy. Zhonghua wai ke za zhi [Chinese journal of surgery] 2009;47:1764-1766.

17. Bartsch DK, et al. A simple and safe anastomosis for pancreatogastrostomy using one binding purse-string and two transfixing mattress sutures. Int J Surg Oncol 2012;2012:718637

18. Addea P, et al. Double purse-string telescoped pancreaticogastrostomy: an expedient, safe, and easy technique. J Am Coll Surg 2013;216:e27.

19. Zhu F, et al. Modified technique of pancreaticogastrostomy for soft pancreas with two continuous hemstitch sutures: a single-center prospective study. J Gastrointest Surg 2013; 17:1306-1311.

Acta Medica Marisiensis

The Journal of The University of Medicine and Pharmacy of Targu-Mures

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