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    Pancreatic Duct Occlusion: A Safe and Valid Alternative to Duct Anastomosis After Pancreaticoduodenectomy in a Low Volume Centre

    Authors: Antonio Giuliani; Aldo Rocca; Anna Lucia Segreto; Marianna Paccone; Maria Lucia Izzo; Antonio Buondonno; Claudio Luciani; Giuseppe Di Natale; Mariagrazia Coluzzi; Klara Komici; Bruno Amato; Fulvio Calise

    doi:10.21203/rs.3.rs-97672/v1 Date: 2020-10-24 Source: ResearchSquare

    Background: Pancreaticoduodenectomy is the only possible choice of treatment for peri-ampoullar neoplasms MESHD. Morbidity in pancreatic MESHD surgery is mainly related to the development of a postoperative pancreatic fistula MESHD ( POPF MESHD). According to International Study Group on Pancreatic Fistula MESHD it is possible to grade POPF MESHD based on clinical variables. Three main different surgical strategies have been proposed to deal with the pancreatic stump MESHD following pancreaticoduodenectomy: pancreatojejunostomy, pancreatogastrostomy and pancreatic duct occlusion MESHD, but none of them has been clearly demonstrated to be superior to the others. The aim of our study is to evaluate the feasibility of duct occlusion MESHD and its correlations with postoperative pancreatic fistula MESHD, “ brittle diabetes MESHD” and overall survival in a low volume centre. We decided to review our previous experience in the light of the recent Covid pandemic where, in our country, it has been forced in many regions to displace treatment of oncological patients in low volume hospitals with limited experienceMethods: We retrospectively reviewed 56 consecutive patients, from a prospective maintained database, who underwent Whipple’s procedure from January 2007 to December 2014 in a tertiary Hepatobiliary MESHD Surgery and Liver Transplant Unit with a low volume of pancreatic resections. The mean follow-up was 24.5 months. Results: The overall incidence of postoperative pancreatic fistula MESHD was 66.6%: 15 patients had a Grade A (31.25%), 13 a Grade B fistula MESHD (27.03%), and 4 (8.3%) suffered from a life-threatening Grade C fistula MESHD. At the last follow-up, 24 of the 28 patients who were alive (85.6%) habitually used substitutive pancreatic MESHD enzyme. Conclusion: Duct occlusion can be a safe alternative to pancreatic anastomosis especially MESHD in low volume centres and for those patients (age >75 years, obese MESHD, hard pancreatic texture MESHD, small pancreatic duct MESHD) at higher risk of clinically relevant POPF MESHD.Trial registration: 'retrospectively registered'

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MeSH Disease
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