Kiguchi Method, A Novel Simplified Technique For Pancreaticojejunostomy In Minimally Invasive Pancreaticoduodenectomy, Significantly Reduces Postoperative Pancreatic Fistula Rate In Patients With A Soft Pancreatic Texture

Abstract Background: Minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), is especially demanding due to pancreaticojejunostomy (PJ). Postoperative pancreatic fistula (POPF) remains the most serious complication in MIPD as well as in open pancreaticoduodenectomy (OPD). Conventional PJ in MIPD did not improve the POPF rate and hospital stay, contrary to expectations. High POPF rates have been attributed to technical issues encountered during MIPD, including motion restriction and insufficient water tightness; therefore, we have developed the Kiguchi method as a novel PJ technique optimized for MIPD. Herein, we describe the technique and assess its impact in patients with a soft pancreatic texture, which has been reported to be significantly related to POPF.Methods: The retrospective study included 188 patients with a soft pancreatic texture. Briefly, 143 patients underwent OPD with conventional PJ (OPD group); 19 patients underwent MIPD with conventional PJ (Old-MIPD group), including 7 and 12 patients undergoing LPD and RPD, respectively; and 26 patients underwent MIPD using the Kiguchi method (New-MIPD group), including 15 and 11 patients undergoing LPD and RPD, respectively. Short-term outcomes were assessed, and POPF risk factors were determined using univariate and multivariate analyses.Results: The grade B/C POPF rate was significantly lower in the New-MIPD group than in the Old-MIPD and OPD groups (3.8% vs. 42.1% and 36.4%, respectively). The median hospital stay was significantly shorter in the New-MIPD group than in the Old-MIPD and OPD groups (23 vs. 33 and 31 days, respectively). By multivariate analysis, the PJ method and male sex were significant POPF risk factors. Among the patients without POPF, the hospital stay was significantly shorter in those undergoing MIPD than in those undergoing OPD, suggesting the advantage of MIPD. Conclusions: The novel Kiguchi method significantly reduced the POPF rate in patients with a soft pancreatic texture.

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Wrapping double-mattress anastomosis for pancreaticojejunostomy in minimally invasive pancreaticoduodenectomy can significantly reduce postoperative pancreatic fistula rate compared with conventional pancreaticojejunostomy in open surgery: An analysis of a propensity score-matched sample

Surgical Oncology ◽

10.1016/j.suronc.2021.101577 ◽

2021 ◽

pp. 101577

Author(s):

Gozo Kiguchi ◽

Atsushi Sugioka ◽

Yuichiro Uchida ◽

Junichi Yoshikawa ◽

Masaya Nakauchi ◽

...

Keyword(s):

Propensity Score ◽

Minimally Invasive ◽

Pancreatic Fistula ◽

Open Surgery ◽

Postoperative Pancreatic Fistula ◽

Matched Sample ◽

Fistula Rate ◽

Pancreatic Fistula Rate

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Minimally Invasive Pancreaticoduodenectomy: Is the Incidence of Clinically Relevant Postoperative Pancreatic Fistula Comparable to That Following Open Pancreaticoduodenectomy?

Gastroenterology ◽

10.1016/s0016-5085(17)34168-9 ◽

2017 ◽

Vol 152 (5) ◽

pp. S1251

Author(s):

Olga Kantor ◽

Mark S. Talamonti ◽

Kevin K. Roggin ◽

David J. Bentrem ◽

Richard A. Prinz ◽

...

Keyword(s):

Minimally Invasive ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Open Pancreaticoduodenectomy

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Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

Revista de Chimie ◽

10.37358/rc.17.12.5997 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2875-2878

Author(s):

Delia Rusu Andriesi ◽

Ana Maria Trofin ◽

Irene Alexandra Cianga Spiridon ◽

Corina Lupascu Ursulescu ◽

Cristian Lupascu

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Pancreatic Surgery ◽

Postoperative Pancreatic Fistula ◽

University Center ◽

Preoperative Hemoglobin ◽

Term Administration ◽

Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

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The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study

Innovative Surgical Sciences ◽

10.1515/iss-2020-0021 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Georgi Kalev ◽

Christoph Marquardt ◽

Herbert Matzke ◽

Paul Matovu ◽

Thomas Schiedeck

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Pancreatic Head ◽

Suture Technique ◽

Postoperative Pancreatic Fistula ◽

Intermediate Care ◽

Pancreatic Head Resection ◽

Pancreatic Anastomosis

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

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Systematic review and meta-analysis of risk factors of postoperative pancreatic fistula after distal pancreatectomy in the era of 2016 International Study Group Pancreatic Fistula definition

HPB ◽

10.1016/j.hpb.2021.02.015 ◽

2021 ◽

Author(s):

Eric Chong ◽

Bathiya Ratnayake ◽

Shiela Lee ◽

Jeremy J. French ◽

Colin Wilson ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Meta Analysis ◽

International Study ◽

Postoperative Pancreatic Fistula ◽

Study Group ◽

International Study Group

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Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

Surgical Innovation ◽

10.1177/1553350618812322 ◽

2018 ◽

Vol 26 (2) ◽

pp. 201-208

Author(s):

Mohamed El Shobary ◽

Ayman El Nakeeb ◽

Ahmad Sultan ◽

Mahmoud Abd El Wahab Ali ◽

Mohamed El Dosoky ◽

...

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Surgical Outcomes ◽

Operative Time ◽

Postoperative Pancreatic Fistula ◽

Tube Removal ◽

Matched Study ◽

The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

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