医学
吻合
支架
胰瘘
外科
放射科
胰管
瘘管
胰腺
内科学
作者
C Hüscher,Giampaolo Perri,Gianni Lazzarin,Giovanni Marchegiani,Giuseppe Malleo,Roberto Salvia,Claudio Bassi
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2021-11-18
卷期号:275 (4): e665-e668
被引量:8
标识
DOI:10.1097/sla.0000000000005316
摘要
Objective: To assess the feasibility and clinical utility of coronary artery stent (CAS) in securing pancreatico-jejunal anastomosis (PJ) and avoid stent displacement after pancreatoduodenectomy (PD). Summary of Background Data: Externalized trans-anastomotic stent (ETS) is a standard mitigation strategy for postoperative pancreatic fistula (POPF) in high-risk patients. However, major morbidity remains extremely elevated, especially in case of ETS malfunction due to displacement. Methods: A pilot series of 72 patients underwent PD and PJ with CAS positioning between January 2016 and December 2019. All patients were at high-risk for POPF (soft pancreatic texture; main pancreatic duct diameter ≤ 3 mm) and underwent a CT-scan at postoperative day 5 and 10 to assess the correct CAS positioning. Postoperative outcomes were analyzed, and displacement rates were compared with a cohort of 141 patients with the same high-risk characteristics, undergoing PD with PJ and externalized trans-anastomotic stent (ETS). Results: No CAS-related complications were registered in the study group. In particular, no CAS displacement was registered, compared to a 28% ETS malfunction (either displacement or occlusion). The POPF rate, major morbidity, and mortality were 11%, 6%, and 0% respectively. Conclusions: The CAS positioning appears to be a feasible and safe mitigation strategy to secure PJ anastomosis after PD with high POPF risk avoiding stent displacement. Further validation and comparison with current standard of care is required in a prospective controlled setting.
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