Department of general and abdominal surgery ARTMED MRC

Department of general and abdominal surgery “ARTMED” MRC

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Technical aspects of pancreatoduodenectomy for periampullery lesions

Sahakyan M.A., Stepanyan S.A., Gabrielyan A.M., Petrosyan H.P., Akunts A.R., Sahakyan A.M.

Pancreatoduodenectomy (PD) is associated with considerable morbid, ranging from 35 to 40%. Thereby, endeavors to improve surgical technique remain highly relevant. The objective of the study was to analyze different technical approaches to crucial steps of PD, such as an extent of surgery, pancreatic anastomosis and external drainage of pancreatic duct (EDPD).

Totally 87 patients with PD were included in this study. Seventy-one patients underwent standard PD (SPD), where's 16 patients were operated by pylorus-preserving PD (PPPD). PPPD was associated with the significant decrease in estimated blood loss (P=0,017). All other perioperative outcomes between SPD and PPPD were similar. End-to-side pancreatojejunostomy lead to significantly higher postoperative mortality, reoperation rate and incidence of intra-abdominal abscesses, compared with the end-to-end technique (P=0,028, 0,021 and 0,021, retrospectively).

Patients with EDPD had significantly more EBL, compared to the group without EDPD (775 (300-1860)mL vs. (500 (200-2300) mL; P=o,o24). The later also resulting in a significant increase in operative time, postoperative morbidity, rate of pancreatic fistula and intra-abdominal abscesses (P=0,001; 0,004; 0,039 and 0,002, respectively).

PPPD seems to have minor advantages over SPD, whereas EDPD is associated with poor outcomes after surgery. As for the type of pancreatic anastomosis, it should be considered based primarily on individual surgeon experience, although end-to-end technique has demonstrated favorable outcomes .

Medicine Science and Educations. Scientific and informational Journal, Yerevan, 2016, January, N20, p. 51-59.

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