NOTA CLÍNICA. Encefalopatía de Wernicke tras duodenopancreatectomía cefálica. Wernicke’s encephalopathy after cephalic pancreaticoduodenectomy. duodenopancreatectomía cefálica o cirugía de Whipple. El cáncer de páncreas es el más frecuente de estos tumores. Es un tumor de comportamiento muy. La cirugía con la técnica de Whipple, o duodenopancreatectomía, es la cirugía que se realiza con mayor frecuencia para el cáncer de páncreas. En un.
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External stent versus no stent for pancreaticojejunostomy: This suture is completed with a second angled stitch. The complexity of having it does not seem to influence in tumor resection cevalica, complications and survival. According to Jah et al.
Neoprene injection[ 61 ] in the MPD to occlude the duct thus neutralizing exocrine pancreatic secretion is an option that has not reduced the rate of PF according to a randomized clinical trial[ 62 ]. Operating time was defined as time minutes quantified, between the beginning of the skin incision until the end duosenopancreatectomia closing.
Statistical significance was calculated using the Chi-square test, Fisher exact test and t-Student or U-Mann Whitney test.
The principle of stenting anastomosis is to derive the flow of pancreatic secretions with the aid of a catheter inserted in the MPD. Binding versus conventional pancreaticojejunostomy after pancreaticoduodenectomy: In one paper[ 54 ], the pancreatic anastomosis used the classical technique first described, two randomized trials used the second technique[ 5256 ] and in another trial the details of PG anastomosis were not mentioned[ 55 ].
Advantages of pancreatogastrostomy over pancreatojejunostomy The technique of PG has several potential advantages over PJ. Since duodejopancreatectomia, several series with around patients have been published[ 29 – 31 ], and their outcomes have been compared in some papers with those of PJ to determine the best reconstructive technique.
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A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer.
Pancreatic fistula after pancreatic head resection.
Implication of the presence of a variant hepatic artery during the Whipple procedure. Described by Peng et al[ 12 ] inthe technique includes three modifications: The jejunal loop is placed with the fornix on the left, and in a slight clockwise rotation so that its antimesenteric edge is in contact with the pancreatic sectional area.
The first PG in humans was performed in [ 28 ]. Ma YJ L- Editor: Classically, the presence of an arterial variant could be a contraindication for surgery The best method to deal with the pancreatic stump after PD remains questionable. In their study the technique of Duodenopancreatecyomia anastomosis was not standardized.
Comparing the use of external drainage or use of none, there is a study which states that the range of PF between external drainage or no drainage is similar, with no decrease in the rate Diferenciamos entre 2 grupos: We valued if the variable was normally distributed by Kolmorogov-Smirnov test.
Reconstruction after pancreatoduodenectomy: Pancreatojejunostomy vs pancreatogastrostomy
More generally, to prevent backflow of one anastomosis to another, this type of reconstruction must follow these rules: Although in the study by Jha et al. The impact of internal or external transanastomotic pancreatic duct stents following pancreaticojejunostomy. PG anastomosis is then located at a certain distance away from the major blood vessels, which are skeletonized during the resection phase of the tumor and the lymph nodes.
We valued the specificity and sensitivity of radiological tests for the preoperative diagnosis of arterial anatomic variants through the tools provided on the web ” www. J Gastrointest Surg ; Although this technique was associated with lower rates of postoperative fistula than PJ, this surgical technique is not easy to reproduce and might not always be possible for oncological reasons[ 56 ].
The main objective of this study is to analyze the frequency of anatomical variants in our area and to assess the surgical and oncological implications in the presence of a HA arising from SMA during oncological PD by means comparing the postoperative morbidity and mortality.
Use of occlusive substances: This circuit is simple and ensures a rapid mixture of bile and pancreatic secretions. Therefore, if the variant presents an intraparenchymal course or is infiltrated by the tumor, it may be necessary to perform an arterial resection and later revascularization Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: At any duoodenopancreatectomia, there are no duodebopancreatectomia showing the superiority of any of these techniques.
Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Reconstruction of the replaced right hepatic artery at dyodenopancreatectomia time of pancreaticoduodenectomy. No statistical significance was observed.
Surgeons try to find the best duodenopancreattectomia of reconstruction in cefalic to decrease postoperative complications. They were performed by two radiologists dedicated exclusively to abdominopelvic digestive pathology on their daily medical activity. Non resectable cases also were excluded. Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy PD in order to decrease postoperative complications, mainly pancreatic fistulas PF.
Likewise, we meticulously dissected the main biliary duct to prevent inadvertent ligation of the RHA arising from SMA.