The “double-fired” gastro-jejunostomy as a form of improved efficiency during Whipple procedure
Gastro-jejunostomy (GJ) after pylorus-resecting pancreatoduodenectomy (PD) is most commonly performed in a hand-sewn fashion. Intestinal stapled anastomosis are reported to be as effective as hand-sewn in terms of patency and risk of leakage in other indications. However, the use of a stapled gastro...
Gespeichert in:
| Veröffentlicht in: | HPB (Oxford, England) England), 2024-04, Vol.26 (4), p.512-520 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 520 |
|---|---|
| container_issue | 4 |
| container_start_page | 512 |
| container_title | HPB (Oxford, England) |
| container_volume | 26 |
| creator | Fiorentini, G. Zironda, A. Fogliati, A. Warner, S. Cleary, S. Smoot, R. Truty, M. Kendrick, M. Nagorney, D. Thiels, C. Starlinger, P. |
| description | Gastro-jejunostomy (GJ) after pylorus-resecting pancreatoduodenectomy (PD) is most commonly performed in a hand-sewn fashion. Intestinal stapled anastomosis are reported to be as effective as hand-sewn in terms of patency and risk of leakage in other indications. However, the use of a stapled gastro-jejunostomy hasn't been fully assessed in PD. The aim of the present technical report is to evaluate functional outcomes of stapled GJ during PD, its associated effect on operative time and related complications.
The institutional database for pancreatic duct adenocarcinoma (PDAC) was retrospectically reviewed. Pylorus resecting open PD without vascular or multivisceral resections were considered for the analysis. The incidence of clinically significant delayed gastric emptying (DGE from the International Stufy Group of Pancreatic Surgery (ISGPS) grade B and C), other complications, operative time and overall hospitalization were evaluated.
Over a 10-years study period, 1182 PD for adenocarcinoma were performed and recorded in the database. 243 open Whipple procedures with no vascular and with no associated multivisceral resections were available and constituted the study population. Hand-sewn (HS) anastomosis was performed in 175 (72 %), stapled anastomosis (St) in 68 (28 %). No significant differences in baseline characteristics were observed between the two groups, with the exception of a higher rate of neoadjuvant chemotherapy in the HS group (74 % St vs. 86 % HS, p = 0.025). Intraoperatively, a significantly reduced median operative time in the St group was observed (248 min St vs. 370 mins HS, p |
| doi_str_mv | 10.1016/j.hpb.2023.12.005 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2928976446</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1365182X23020129</els_id><sourcerecordid>2928976446</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-c2509f6ef16bb85ed605f1fc60f76f514c4900738e18ecdf7b6ce813f13195143</originalsourceid><addsrcrecordid>eNp9kM1O3DAURq2qqAzQB2CDvOwmwddJnERdVaPyIyGxAcHOSuxrxlEyTu1kpNnNg5SX40kwHcqSlS37fN_VPYScAkuBgTjv0tXYppzxLAWeMlZ8IQvIyzLhRZl_jfdMFAlU_PGQHIXQMcZjrP5GDrMKqjwXbEHU3Qrpy-6vdnPbY2KsR_2ye6ZPTZi8Szrs5rULkxu2tAm0ocb5gTpD7TB6t0FN0RirLK7VlurZ2_UTfVjZceyRRkBhfMMTcmCaPuD39_OY3F_8vlteJTe3l9fLXzeJylgxJYoXrDYCDYi2rQrUghUGjBLMlMIUkKu8ZqzMKoQKlTZlKxRWkBnIoI7f2TH5se-Nk__MGCY52KCw75s1ujlIXvOqLkVcPKKwR5V3IXg0cvR2aPxWApNvbmUno1v55lYCl9FtzJy918_tgPoj8V9mBH7uAYxLbix6Gf6ZQR2tqklqZz-pfwWCN4yI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2928976446</pqid></control><display><type>article</type><title>The “double-fired” gastro-jejunostomy as a form of improved efficiency during Whipple procedure</title><source>MEDLINE</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Fiorentini, G. ; Zironda, A. ; Fogliati, A. ; Warner, S. ; Cleary, S. ; Smoot, R. ; Truty, M. ; Kendrick, M. ; Nagorney, D. ; Thiels, C. ; Starlinger, P.</creator><creatorcontrib>Fiorentini, G. ; Zironda, A. ; Fogliati, A. ; Warner, S. ; Cleary, S. ; Smoot, R. ; Truty, M. ; Kendrick, M. ; Nagorney, D. ; Thiels, C. ; Starlinger, P.</creatorcontrib><description>Gastro-jejunostomy (GJ) after pylorus-resecting pancreatoduodenectomy (PD) is most commonly performed in a hand-sewn fashion. Intestinal stapled anastomosis are reported to be as effective as hand-sewn in terms of patency and risk of leakage in other indications. However, the use of a stapled gastro-jejunostomy hasn't been fully assessed in PD. The aim of the present technical report is to evaluate functional outcomes of stapled GJ during PD, its associated effect on operative time and related complications.
The institutional database for pancreatic duct adenocarcinoma (PDAC) was retrospectically reviewed. Pylorus resecting open PD without vascular or multivisceral resections were considered for the analysis. The incidence of clinically significant delayed gastric emptying (DGE from the International Stufy Group of Pancreatic Surgery (ISGPS) grade B and C), other complications, operative time and overall hospitalization were evaluated.
Over a 10-years study period, 1182 PD for adenocarcinoma were performed and recorded in the database. 243 open Whipple procedures with no vascular and with no associated multivisceral resections were available and constituted the study population. Hand-sewn (HS) anastomosis was performed in 175 (72 %), stapled anastomosis (St) in 68 (28 %). No significant differences in baseline characteristics were observed between the two groups, with the exception of a higher rate of neoadjuvant chemotherapy in the HS group (74 % St vs. 86 % HS, p = 0.025). Intraoperatively, a significantly reduced median operative time in the St group was observed (248 min St vs. 370 mins HS, p < 0.001). Post-operatively, rates of clinically relevant delayed gastric emptying (7 % St vs. 14 % HS, p = 0.140), clinically relevant pancreatic fistula (10 % St, 15 % HS, p = 0.300), median length of stay (7 days for each group, p = 0.289), post-pancreatectomy hemorrhage (4.4 % St vs. 6.3 % HS, p = 0.415) and complication rate (22 % St vs. 34 % HS, p = 0.064) were similar between groups. However, readmission rates were significantly lower after St GJ (13.2 % St vs 29.7 % HS, p = 0.008).
Our results indicate that a stapled GJ anastomosis during a standard Whipple procedure is non-inferior to a hand-sewn GJ, with a comparable rate of DGE and no increase of gastrointestinal related long term complications. Further, a stapled GJ anastomosis might be associated with reduced operative times.</description><identifier>ISSN: 1365-182X</identifier><identifier>ISSN: 1477-2574</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1016/j.hpb.2023.12.005</identifier><identifier>PMID: 38184460</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adenocarcinoma - complications ; Adenocarcinoma - surgery ; Anastomosis, Surgical - methods ; Gastroparesis - etiology ; Humans ; Jejunostomy - adverse effects ; Jejunostomy - methods ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Postoperative Complications - etiology ; Surgical Stapling - adverse effects</subject><ispartof>HPB (Oxford, England), 2024-04, Vol.26 (4), p.512-520</ispartof><rights>2023 International Hepato-Pancreato-Biliary Association Inc.</rights><rights>Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c305t-c2509f6ef16bb85ed605f1fc60f76f514c4900738e18ecdf7b6ce813f13195143</cites><orcidid>0000-0003-0615-3107 ; 0000-0003-3654-8601 ; 0000-0002-1186-1979</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38184460$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fiorentini, G.</creatorcontrib><creatorcontrib>Zironda, A.</creatorcontrib><creatorcontrib>Fogliati, A.</creatorcontrib><creatorcontrib>Warner, S.</creatorcontrib><creatorcontrib>Cleary, S.</creatorcontrib><creatorcontrib>Smoot, R.</creatorcontrib><creatorcontrib>Truty, M.</creatorcontrib><creatorcontrib>Kendrick, M.</creatorcontrib><creatorcontrib>Nagorney, D.</creatorcontrib><creatorcontrib>Thiels, C.</creatorcontrib><creatorcontrib>Starlinger, P.</creatorcontrib><title>The “double-fired” gastro-jejunostomy as a form of improved efficiency during Whipple procedure</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description>Gastro-jejunostomy (GJ) after pylorus-resecting pancreatoduodenectomy (PD) is most commonly performed in a hand-sewn fashion. Intestinal stapled anastomosis are reported to be as effective as hand-sewn in terms of patency and risk of leakage in other indications. However, the use of a stapled gastro-jejunostomy hasn't been fully assessed in PD. The aim of the present technical report is to evaluate functional outcomes of stapled GJ during PD, its associated effect on operative time and related complications.
The institutional database for pancreatic duct adenocarcinoma (PDAC) was retrospectically reviewed. Pylorus resecting open PD without vascular or multivisceral resections were considered for the analysis. The incidence of clinically significant delayed gastric emptying (DGE from the International Stufy Group of Pancreatic Surgery (ISGPS) grade B and C), other complications, operative time and overall hospitalization were evaluated.
Over a 10-years study period, 1182 PD for adenocarcinoma were performed and recorded in the database. 243 open Whipple procedures with no vascular and with no associated multivisceral resections were available and constituted the study population. Hand-sewn (HS) anastomosis was performed in 175 (72 %), stapled anastomosis (St) in 68 (28 %). No significant differences in baseline characteristics were observed between the two groups, with the exception of a higher rate of neoadjuvant chemotherapy in the HS group (74 % St vs. 86 % HS, p = 0.025). Intraoperatively, a significantly reduced median operative time in the St group was observed (248 min St vs. 370 mins HS, p < 0.001). Post-operatively, rates of clinically relevant delayed gastric emptying (7 % St vs. 14 % HS, p = 0.140), clinically relevant pancreatic fistula (10 % St, 15 % HS, p = 0.300), median length of stay (7 days for each group, p = 0.289), post-pancreatectomy hemorrhage (4.4 % St vs. 6.3 % HS, p = 0.415) and complication rate (22 % St vs. 34 % HS, p = 0.064) were similar between groups. However, readmission rates were significantly lower after St GJ (13.2 % St vs 29.7 % HS, p = 0.008).
Our results indicate that a stapled GJ anastomosis during a standard Whipple procedure is non-inferior to a hand-sewn GJ, with a comparable rate of DGE and no increase of gastrointestinal related long term complications. Further, a stapled GJ anastomosis might be associated with reduced operative times.</description><subject>Adenocarcinoma - complications</subject><subject>Adenocarcinoma - surgery</subject><subject>Anastomosis, Surgical - methods</subject><subject>Gastroparesis - etiology</subject><subject>Humans</subject><subject>Jejunostomy - adverse effects</subject><subject>Jejunostomy - methods</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Postoperative Complications - etiology</subject><subject>Surgical Stapling - adverse effects</subject><issn>1365-182X</issn><issn>1477-2574</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1O3DAURq2qqAzQB2CDvOwmwddJnERdVaPyIyGxAcHOSuxrxlEyTu1kpNnNg5SX40kwHcqSlS37fN_VPYScAkuBgTjv0tXYppzxLAWeMlZ8IQvIyzLhRZl_jfdMFAlU_PGQHIXQMcZjrP5GDrMKqjwXbEHU3Qrpy-6vdnPbY2KsR_2ye6ZPTZi8Szrs5rULkxu2tAm0ocb5gTpD7TB6t0FN0RirLK7VlurZ2_UTfVjZceyRRkBhfMMTcmCaPuD39_OY3F_8vlteJTe3l9fLXzeJylgxJYoXrDYCDYi2rQrUghUGjBLMlMIUkKu8ZqzMKoQKlTZlKxRWkBnIoI7f2TH5se-Nk__MGCY52KCw75s1ujlIXvOqLkVcPKKwR5V3IXg0cvR2aPxWApNvbmUno1v55lYCl9FtzJy918_tgPoj8V9mBH7uAYxLbix6Gf6ZQR2tqklqZz-pfwWCN4yI</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Fiorentini, G.</creator><creator>Zironda, A.</creator><creator>Fogliati, A.</creator><creator>Warner, S.</creator><creator>Cleary, S.</creator><creator>Smoot, R.</creator><creator>Truty, M.</creator><creator>Kendrick, M.</creator><creator>Nagorney, D.</creator><creator>Thiels, C.</creator><creator>Starlinger, P.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0615-3107</orcidid><orcidid>https://orcid.org/0000-0003-3654-8601</orcidid><orcidid>https://orcid.org/0000-0002-1186-1979</orcidid></search><sort><creationdate>202404</creationdate><title>The “double-fired” gastro-jejunostomy as a form of improved efficiency during Whipple procedure</title><author>Fiorentini, G. ; Zironda, A. ; Fogliati, A. ; Warner, S. ; Cleary, S. ; Smoot, R. ; Truty, M. ; Kendrick, M. ; Nagorney, D. ; Thiels, C. ; Starlinger, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-c2509f6ef16bb85ed605f1fc60f76f514c4900738e18ecdf7b6ce813f13195143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adenocarcinoma - complications</topic><topic>Adenocarcinoma - surgery</topic><topic>Anastomosis, Surgical - methods</topic><topic>Gastroparesis - etiology</topic><topic>Humans</topic><topic>Jejunostomy - adverse effects</topic><topic>Jejunostomy - methods</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Postoperative Complications - etiology</topic><topic>Surgical Stapling - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fiorentini, G.</creatorcontrib><creatorcontrib>Zironda, A.</creatorcontrib><creatorcontrib>Fogliati, A.</creatorcontrib><creatorcontrib>Warner, S.</creatorcontrib><creatorcontrib>Cleary, S.</creatorcontrib><creatorcontrib>Smoot, R.</creatorcontrib><creatorcontrib>Truty, M.</creatorcontrib><creatorcontrib>Kendrick, M.</creatorcontrib><creatorcontrib>Nagorney, D.</creatorcontrib><creatorcontrib>Thiels, C.</creatorcontrib><creatorcontrib>Starlinger, P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>HPB (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fiorentini, G.</au><au>Zironda, A.</au><au>Fogliati, A.</au><au>Warner, S.</au><au>Cleary, S.</au><au>Smoot, R.</au><au>Truty, M.</au><au>Kendrick, M.</au><au>Nagorney, D.</au><au>Thiels, C.</au><au>Starlinger, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The “double-fired” gastro-jejunostomy as a form of improved efficiency during Whipple procedure</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2024-04</date><risdate>2024</risdate><volume>26</volume><issue>4</issue><spage>512</spage><epage>520</epage><pages>512-520</pages><issn>1365-182X</issn><issn>1477-2574</issn><eissn>1477-2574</eissn><abstract>Gastro-jejunostomy (GJ) after pylorus-resecting pancreatoduodenectomy (PD) is most commonly performed in a hand-sewn fashion. Intestinal stapled anastomosis are reported to be as effective as hand-sewn in terms of patency and risk of leakage in other indications. However, the use of a stapled gastro-jejunostomy hasn't been fully assessed in PD. The aim of the present technical report is to evaluate functional outcomes of stapled GJ during PD, its associated effect on operative time and related complications.
The institutional database for pancreatic duct adenocarcinoma (PDAC) was retrospectically reviewed. Pylorus resecting open PD without vascular or multivisceral resections were considered for the analysis. The incidence of clinically significant delayed gastric emptying (DGE from the International Stufy Group of Pancreatic Surgery (ISGPS) grade B and C), other complications, operative time and overall hospitalization were evaluated.
Over a 10-years study period, 1182 PD for adenocarcinoma were performed and recorded in the database. 243 open Whipple procedures with no vascular and with no associated multivisceral resections were available and constituted the study population. Hand-sewn (HS) anastomosis was performed in 175 (72 %), stapled anastomosis (St) in 68 (28 %). No significant differences in baseline characteristics were observed between the two groups, with the exception of a higher rate of neoadjuvant chemotherapy in the HS group (74 % St vs. 86 % HS, p = 0.025). Intraoperatively, a significantly reduced median operative time in the St group was observed (248 min St vs. 370 mins HS, p < 0.001). Post-operatively, rates of clinically relevant delayed gastric emptying (7 % St vs. 14 % HS, p = 0.140), clinically relevant pancreatic fistula (10 % St, 15 % HS, p = 0.300), median length of stay (7 days for each group, p = 0.289), post-pancreatectomy hemorrhage (4.4 % St vs. 6.3 % HS, p = 0.415) and complication rate (22 % St vs. 34 % HS, p = 0.064) were similar between groups. However, readmission rates were significantly lower after St GJ (13.2 % St vs 29.7 % HS, p = 0.008).
Our results indicate that a stapled GJ anastomosis during a standard Whipple procedure is non-inferior to a hand-sewn GJ, with a comparable rate of DGE and no increase of gastrointestinal related long term complications. Further, a stapled GJ anastomosis might be associated with reduced operative times.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38184460</pmid><doi>10.1016/j.hpb.2023.12.005</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0615-3107</orcidid><orcidid>https://orcid.org/0000-0003-3654-8601</orcidid><orcidid>https://orcid.org/0000-0002-1186-1979</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1365-182X |
| ispartof | HPB (Oxford, England), 2024-04, Vol.26 (4), p.512-520 |
| issn | 1365-182X 1477-2574 1477-2574 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2928976446 |
| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Adenocarcinoma - complications Adenocarcinoma - surgery Anastomosis, Surgical - methods Gastroparesis - etiology Humans Jejunostomy - adverse effects Jejunostomy - methods Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - methods Postoperative Complications - etiology Surgical Stapling - adverse effects |
| title | The “double-fired” gastro-jejunostomy as a form of improved efficiency during Whipple procedure |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-03T09%3A31%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20%E2%80%9Cdouble-fired%E2%80%9D%20gastro-jejunostomy%20as%20a%20form%20of%20improved%20efficiency%20during%20Whipple%20procedure&rft.jtitle=HPB%20(Oxford,%20England)&rft.au=Fiorentini,%20G.&rft.date=2024-04&rft.volume=26&rft.issue=4&rft.spage=512&rft.epage=520&rft.pages=512-520&rft.issn=1365-182X&rft.eissn=1477-2574&rft_id=info:doi/10.1016/j.hpb.2023.12.005&rft_dat=%3Cproquest_cross%3E2928976446%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2928976446&rft_id=info:pmid/38184460&rft_els_id=S1365182X23020129&rfr_iscdi=true |