Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy

Abstract Background Pylorus-preserving pancreatoduodenectomy (PPPD) with pancreatogastrostomy is a standard surgical procedure for pancreatic head tumors, duodenal tumors and distal cholangiocarcinomas. Post-operative pancreatic fistulas (POPF) are a major complication causing relevant morbidity and...

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Autores principales:	Dominik J. Kaczmarek, Dominik J. Heling, Maria A. Gonzalez-Carmona, Christian P. Strassburg, Vittorio Branchi, Hanno Matthaei, Jörg Kalff, Steffen Manekeller, Tim R. Glowka, Tobias J. Weismüller
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Endo-sponge Endoscopic vacuum-assisted wound closure system Anastomotic leakage Pancreaticogastric anastomotic insufficiency Pancreaticogastrostomy Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/d04f8387e94a444b92c1f67b5c30505f
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spelling	oai:doaj.org-article:d04f8387e94a444b92c1f67b5c30505f2021-11-14T12:16:48ZManagement of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy10.1186/s12876-021-02000-31471-230Xhttps://doaj.org/article/d04f8387e94a444b92c1f67b5c30505f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12876-021-02000-3https://doaj.org/toc/1471-230XAbstract Background Pylorus-preserving pancreatoduodenectomy (PPPD) with pancreatogastrostomy is a standard surgical procedure for pancreatic head tumors, duodenal tumors and distal cholangiocarcinomas. Post-operative pancreatic fistulas (POPF) are a major complication causing relevant morbidity and mortality. Endoscopic vacuum therapy (EVT) has become a widely used method for the treatment of intestinal perforations and leakages. Here we report on a pilot single center series of 8 POPF cases specifically caused by dehiscences of the pancreatogastric anastomosis (PGD), successfully managed by EVT. Methods We included all patients with PGD after PPPD, who were treated with EVT between 07/2017 and 08/2020. For EVT a vacuum drainage film (EVT film) or open-pore polyurethane foam sponge (EVT sponge) was fixed to a 14Fr or 16Fr suction catheter and placed endoscopically within the PGD for intracavitary EVT with continuous suction between − 100 and − 150 mmHg. The EVT film/sponge was exchanged twice per week. EVT was discontinued when the PGD was sufficiently healed. Results PGD closure was achieved in 7 of 8 patients after a mean EVT time of 16 days (range 8–38) and 3 EVT film/sponge exchanges (range 1–9). One patient died on day 18 after PPPD from acute hemorrhagic shock, unlikely related to EVT, before effectiveness of EVT could be fully achieved. There were no adverse events directly attributable to EVT. Conclusions EVT could be an effective and safe addition to our therapeutic armamentarium in the management of POPF with PGD. Unless prospective comparative studies are available, EVT as minimally invasive therapeutic alternative should be considered individually by an interdisciplinary team involving endoscopists, surgeons and radiologists.Dominik J. KaczmarekDominik J. HelingMaria A. Gonzalez-CarmonaChristian P. StrassburgVittorio BranchiHanno MatthaeiJörg KalffSteffen ManekellerTim R. GlowkaTobias J. WeismüllerBMCarticleEndo-spongeEndoscopic vacuum-assisted wound closure systemAnastomotic leakagePancreaticogastric anastomotic insufficiencyPancreaticogastrostomyDiseases of the digestive system. GastroenterologyRC799-869ENBMC Gastroenterology, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Endo-sponge Endoscopic vacuum-assisted wound closure system Anastomotic leakage Pancreaticogastric anastomotic insufficiency Pancreaticogastrostomy Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Endo-sponge Endoscopic vacuum-assisted wound closure system Anastomotic leakage Pancreaticogastric anastomotic insufficiency Pancreaticogastrostomy Diseases of the digestive system. Gastroenterology RC799-869 Dominik J. Kaczmarek Dominik J. Heling Maria A. Gonzalez-Carmona Christian P. Strassburg Vittorio Branchi Hanno Matthaei Jörg Kalff Steffen Manekeller Tim R. Glowka Tobias J. Weismüller Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
description	Abstract Background Pylorus-preserving pancreatoduodenectomy (PPPD) with pancreatogastrostomy is a standard surgical procedure for pancreatic head tumors, duodenal tumors and distal cholangiocarcinomas. Post-operative pancreatic fistulas (POPF) are a major complication causing relevant morbidity and mortality. Endoscopic vacuum therapy (EVT) has become a widely used method for the treatment of intestinal perforations and leakages. Here we report on a pilot single center series of 8 POPF cases specifically caused by dehiscences of the pancreatogastric anastomosis (PGD), successfully managed by EVT. Methods We included all patients with PGD after PPPD, who were treated with EVT between 07/2017 and 08/2020. For EVT a vacuum drainage film (EVT film) or open-pore polyurethane foam sponge (EVT sponge) was fixed to a 14Fr or 16Fr suction catheter and placed endoscopically within the PGD for intracavitary EVT with continuous suction between − 100 and − 150 mmHg. The EVT film/sponge was exchanged twice per week. EVT was discontinued when the PGD was sufficiently healed. Results PGD closure was achieved in 7 of 8 patients after a mean EVT time of 16 days (range 8–38) and 3 EVT film/sponge exchanges (range 1–9). One patient died on day 18 after PPPD from acute hemorrhagic shock, unlikely related to EVT, before effectiveness of EVT could be fully achieved. There were no adverse events directly attributable to EVT. Conclusions EVT could be an effective and safe addition to our therapeutic armamentarium in the management of POPF with PGD. Unless prospective comparative studies are available, EVT as minimally invasive therapeutic alternative should be considered individually by an interdisciplinary team involving endoscopists, surgeons and radiologists.
format	article
author	Dominik J. Kaczmarek Dominik J. Heling Maria A. Gonzalez-Carmona Christian P. Strassburg Vittorio Branchi Hanno Matthaei Jörg Kalff Steffen Manekeller Tim R. Glowka Tobias J. Weismüller
author_facet	Dominik J. Kaczmarek Dominik J. Heling Maria A. Gonzalez-Carmona Christian P. Strassburg Vittorio Branchi Hanno Matthaei Jörg Kalff Steffen Manekeller Tim R. Glowka Tobias J. Weismüller
author_sort	Dominik J. Kaczmarek
title	Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
title_short	Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
title_full	Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
title_fullStr	Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
title_full_unstemmed	Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
title_sort	management of post-operative pancreatic fistulas following longmire–traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d04f8387e94a444b92c1f67b5c30505f
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Management of post-operative pancreatic fistulas following Longmire–Traverso pylorus-preserving pancreatoduodenectomy by endoscopic vacuum-assisted closure therapy

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