In order to further standardize the prevention and treatment of postoperative complications of pancreatic surgery, the editorial board of the Chinese Journal of Surgery organized relevant experts to formulate this guideline under the promotion of the Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association. According to the grading of recommendations assessment, development, and evaluation system, this guide discusses the hot issues on postoperative complications such as pancreatic fistula, biliary fistula, chylous fistula, post-pancreatectomy hemorrhage, abdominal infection, delayed gastric emptying, etc., quantitatively evaluates the level of evidence in clinical studies, and forms recommendations after repeatedly consulting. It is hoped to provide reference for pancreatic surgeons in the prevention and treatment of postoperative complications.
Humans ; Postoperative Complications/etiology* ; Pancreatectomy/adverse effects* ; Pancreaticoduodenectomy/adverse effects* ; Pancreatic Fistula/prevention & control* ; China

Objective: To investigate the safety and efficacy of embedding the stump of gastroduodenal artery between the left lateral lobe of the liver and the left caudate lobe to prevent bleeding after laparoscopic pancreaticoduodenectomy. Methods: The clinical data of 41 patients who underwent laparoscopic pancreaticoduodenectomy at the second Hospital of Hebei Medical University from October 2021 to April 2022 were analyzed retrospectively.There were 27 males and 14 females, aged (63.0±9.2)years (range: 48 to 78 years), and the body mass index was (24.1±3.2)kg/m² (range: 15.4 to 31.6 kg/m²). After routine laparoscopic pancreaticoduodenectomy, the stump of gastroduodenal artery was embedded between the left lateral lobe and the left caudate lobe of the liver, and the hepatic parenchyma of the left lateral lobe and the left caudate lobe were sutured with absorbable sutures.The occurrence and recovery of postoperative complications (pancreatic fistula, biliary fistula, postoperative abdominal bleeding, abdominal infection, liver abscess) were observed. Results: All the operations of 41 patients were completed successfully.The operation time was (277.5±52.0) minutes (range: 192 to 360 minutes). The entrapment time of gastroduodenal artery stump was (3.1±0.6) minutes (range: 2.3 to 4.2 minutes), and the intraoperative blood loss (M(IQR)) was 300 (200) ml (range: 50 to 800 ml).The results of ultrasound examination of hepatic artery on the first day after operation showed that the blood flows of hepatic artery were unobstructed.Postoperative pancreatic fistula occurred in 3 cases, including grade B pancreatic fistula in 2 cases (1 case with abdominal infection) and biochemical leakage in 1 case. Three patients with pancreatic fistula were discharged successfully after continuous abdominal drainage. There was no biliary fistula, abdominal bleeding, abdominal infection, liver abscess or postoperative liver dysfunction. Conclusion: The encasement of the gastroduodenal artery stump by the left outer and left caudate lobes of the liver may be an effective way to prevent bleeding from the rupture of the gastroduodenal artery stump after laparoscopic pancreatoduodenectomy, which is easy and safe to perform.
Female ; Male ; Humans ; Hepatic Artery ; Pancreaticoduodenectomy ; Pancreatic Fistula ; Retrospective Studies ; Laparoscopy ; Liver Abscess ; Intraabdominal Infections ; Postoperative Hemorrhage/prevention & control*

Pancreaticojejunostomy is the most common anastomosis following pancreaticoduodenectomy and middle pancreatectomy. The detailed surgical technics of pancreaticojejunostomy vary dramatically, but none of them can achieve zero fistula rate. In recent years,with the development of new surgical concept,application of new surgical technology, high-tech materials and instruments,the incidence of pancreatic fistula has decreased. At the same time,researches on investigating the risk factors of pancreaticojejunostomy are gradually deepening. Based on years of surgical experience on pancreaticojejunostomy and current literatures, this paper analyzes the factors affecting the effect of pancreaticojejunostomy, such as the patient's basic physical state,pancreatic texture and diameter of the pancreatic duct,pathology and course of the disease,surgical technology and perioperative management,and summarizes six technical principles for pancreaticojejunostomy to be shared with surgical comrades:appropriate tension,protection of blood supply,hermetic closure of pancreatic section,accurate connection of pancreatic duct and intestinal mucosa,individualization,learning and accumulation of experience.
Anastomosis, Surgical/adverse effects* ; Humans ; Pancreatic Fistula/prevention & control* ; Pancreaticoduodenectomy/adverse effects* ; Pancreaticojejunostomy/adverse effects* ; Postoperative Complications/epidemiology* ; Treatment Outcome

OBJECTIVETo investigate the effect of pancreatic duct stent internal versus external drainage with pancreaticojejunostomy on the early curative effect after pancreaticoduodenectomy (PD).

METHODSThe study was a prospective controlled trial. A total of 219 patients undergoing PD from January 2010 to March 2013 were randomly divided into external drainage group (n = 110) and internal drainage group (n = 109). The pancreatic duct stent was put in the jejunum during the operation in the internal drainage group, while that in the external drainage group was placed outside the body through the jejunum and abdominal wall. The intra-operative blood loss, operative duration, post-operative hospital stay, mortality rate, and the morbidity of pancreatic fistula as well as other complications were compared between the two groups.

RESULTSCompared with internal drainage group, pancreatic duct stent external drainage obviously reduced the morbidity of pancreatic fistula (13.6% vs. 22.6%), delayed gastric emptying (10.0% vs. 27.5%), abdominal infection (6.4% vs. 19.3%), intestinal obstruction (8.2% vs. 20.2%) along with the overall complications (24.5% vs. 41.3%) after PD (χ(2) = 5.735 8 to 11.047 7, P < 0.05), and shortened the healing duration of pancreatic fistula ((11.5 ± 2.9) d vs. (20.1 ± 5.7) d, t = 5.07, P < 0.01), while there was no significant difference in the intra-operative blood loss, operative duration, post-operative hospital stay and mortality rate, etc between the two groups (P > 0.05).

CONCLUSIONSPancreatic duct stent external drainage can effectively reduce the morbidity of pancreatic fistula and the overall complications after PD, which is safe and feasible. The method is worthy of popularization and application clinically.

Adult ; Aged ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; surgery ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreaticoduodenectomy ; Postoperative Complications ; prevention & control ; Prospective Studies ; Treatment Outcome

Pancreatic enteric anastomosis is an important step during pancreaticoduodenectomy. Based on the anastomosis site, pancreatic enteric anastomosis is classified as pancreaticojejunostomy anastomosis and pancreaticogastrostomy. Depending on the jejunum site, reconstruction can be perform as end-to-end or end-to-side anastomosis. Previous randomized clinical trials, showed no significant differences between pancreaticojejunostomy and pancreaticogastrostomy. Binding pancreaticojejunostomy and binding pancreaticogastrostomy are easy to perform. The rate of pancreatic leakage is related to the texture of the pancreas and the size of the pancreatic duct. It is helpful to reduce pancreatic leakage by placing a pancreatic duct stent. The simple and effective pancreatic enteric reconstruction is the future direction for minimizing leakage.
Humans ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; methods

OBJECTIVETo explore the effect of drainage in cavities on preventing from grade B and C of the pancreatic fistula after pancreaticoduodenectomy (PD).

METHODSFrom June 2008 to June 2010, the medical team had performed the operations of digestive tract reconstruction by the same way in 68 cases with PD. There were 43 male and 25 female patients, with a mean age of (64 ± 3) years. The patients were simply randomly divided into drainage in cavities group (DC, n = 32) and conventional drainage group (CD, n = 36) according to the different drainage way. The methods of drainage in cavities were composed of three aspects which include drainage in main pancreatic duct, drainage around cholecystojejunostomy anastomosis and peripancreatic drainage. The clinical parameters of the two groups were collected. The characteristics of the drainage juice which include color, volume and amylase value in the two groups were compared. The incidence and severity grading of pancreatic fistula between the two groups were evaluated.

RESULTSThe average of amylase value and the peripancreatic drainage flow were (1401 ± 8) U/L and (49 ± 5) ml in the DC group. Their average in the CD group were (2160 ± 13) U/L and (76 ± 4) ml. There was significant statistical difference in the peripancreatic drainage flow between the two groups (t = 2.597, P = 0.031). The amylase values of the drainage juice between the two groups were of no statistical difference (P > 0.05). According to the definition of pancreatic fistula by an international study group, the incidence of pancreatic fistula in the DC group was 25.0% (8/32) and the CD group 30.5% (11/36) (P > 0.05). The proportion of grades B and C of pancreatic fistula in the DC group had statistical difference compared with one of the CD group (χ(2) = 4.797, P = 0.029).

CONCLUSIONDrainage in cavities could significantly decrease and the occurring ratio of grade B and C of pancreatic fistula after PD.

Aged ; Anastomosis, Surgical ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Fistula ; prevention & control ; Pancreaticoduodenectomy ; Postoperative Complications ; prevention & control

Pancreaticoduodenectomy(PD) has been widely accepted as one of the most complicated operation in abdominal surgery. The patients who receive PD operation always have other concurrent conditions, such as jaundice, diabetes, liver dysfunction, and malnutrition. Pancreatic fistula, biliary fistula and gastrointestinal dysfunction are common complications after PD. Proper perioperative management and fluid administration can reduce postoperative complications and the mortality.
Anastomosis, Surgical ; Drainage ; Fluid Therapy ; Humans ; Nutritional Support ; Pancreatic Fistula ; surgery ; therapy ; Pancreaticoduodenectomy ; Postoperative Complications ; prevention & control

OBJECTIVETo analyze the influence of pancreatic fistula in middle segmental pancreatic resection and summarize the experience in dealing with the stump.

METHODSThe data of 40 cases undergoing middle pancreatectomy were reviewed retrospectively to analyze the curative effect and pancreatic fistula between April 2003 and December 2009. Of these, 36 patients with benign cases outcomes were compared with 2 separate control groups, 44 pancreaticoduodenectomy (PD) and 26 extended distal pancreatectomy (EDP).

RESULTSThe mean operating time of group MSP was 222 min, which was significantly shorter than that of group PD. The mean blood loss of group MSP was 316 ml, which was less than that of others. Otherwise, the postoperative nutritional status and blood sugar control in group MSP was superior to the other 2 groups. Through long-term follow-up, the patients in group MSP retained endocrine and exocrine function better. Only 1 patient developed new-onset diabetes mellitus after operation, and no patient required enzyme substitution. No lesion recurred. The rate of pancreatic fistula was highest (42%), but didn't result in the significant deference of overall discharge time with group PD and EDP. The pancreatic fistula level and the mean postoperative time in hospital didn't differ significantly from the other 2 groups.

CONCLUSIONSMiddle segmental pancreatectomy is a safe and feasible technique that is indicated for selected patients with benign or low malignant lesion in the neck and body of the pancreas. Though the rate of pancreatic fistula is higher, the risk of which is reduced by the marked curative effect. It is very important to deal with the stump reasonably.

Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreatic Neoplasms ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the causes and the measures of prevention and cure of the dangerous complications (bleeding, pancreatic fistula, biliary fistula and death) after radical pancreatoduodenectomy (RPD) for periampullary malignant tumor.

METHODSThe rate and management of dangerous complications of 156 cases with RPD which were continuous performed by Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2006 and June 2008 were analyzed retrospectively, including 97 males and 59 females with 37 - 79 years old, the mean age was 56.9 years old.

RESULTSAmong the 156 cases with RPD, four patients had massive hemorrhage of gastrointestinal tract due to stress ulcer, two patients had bleeding in the pancreas-intestinal anastomosis after the operation, the rate of postoperative bleeding was 3.9% (6/156). One patient with massive hemorrhage of gastrointestinal tract due to stress ulcer had severe pulmonary infection and ARDS, and died of respiratory failure finally (the overall mortality rate was 0.7%) after ICU for two months. One patients with bleeding in the pancreas-intestinal anastomosis had pancreatic fistula (the rate of pancreatic fistula was 0.7%) 3 days after the second laparotomy to open the jejunum of the pancreas-intestinal anastomosis and make a transfixion of the bleeding points in the stump. Another patient who had the tumor located in the inferior segment of the bile common duct had biliary fistula 11 days after the operation (the rate of biliary fistula was 0.7%). Two patients with fistula had good recovery by expectant treatment of ultrasound-guided puncture and drainage.

CONCLUSIONSPrompt and effective treatment of the complications of bleeding, pancreatic fistula, biliary fistula could maximally decrease the perioperative death rate.

Adult ; Aged ; Ampulla of Vater ; Biliary Fistula ; etiology ; prevention & control ; Common Bile Duct Neoplasms ; surgery ; Duodenal Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreatic Neoplasms ; surgery ; Pancreaticoduodenectomy ; adverse effects ; mortality ; Postoperative Complications ; prevention & control ; Postoperative Hemorrhage ; prevention & control ; Retrospective Studies

OBJECTIVETo determine the influence of hand-sewn and stapler in distal pancreatectomy on the postoperative complication.

METHODSClinical data of 109 patients after distal pancreatectomy from January 2003 to December 2006 were analyzed retrospectively.

RESULTSThe surgical techniques used for closure of the pancreatic stump after distal pancreatectomy were categorized into hand-sewn closure group (n = 53) and stapler closure group (n = 56). In stapler closure group, 25 patients accepted laparoscopic operation. The incidences of abdominal infection and pancreatic fistulae in stapler closure group were lower than hand-sewn closure group. The operation time, blood infusion, postoperative bleeding and medical costs were similar between two groups.

CONCLUSIONStapler closure in distal pancreatectomy could decrease the incidence of pancreatic fistula and abdominal infections.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; adverse effects ; instrumentation ; methods ; Pancreatic Fistula ; etiology ; prevention & control ; Pancreatic Neoplasms ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Surgical Staplers ; Surgical Wound Infection ; prevention & control ; Young Adult