The comparative analysis of the area of anastomosis at various options of a pancreatojejunostomy
Abstract
Background. Results of surgical treatment of chronic pancreatitis depend on efficiency of functioning pancreaticojejunostomy. Considering an organ-preserving trend, development of new ways of operations with increase in the area of an anastomosis is one of the challenges of a surgical pancreatology.
Aim – to conduct a comparative assessment of indicators of the area of anastomosis in different variants of pancreat(-ic)ojejunostomy.
Material and methods. The prospective controlled research with calculation of the area of anastomosis according to presurgical and intraoperative diagnostics at 41 patients with chronic pancreatitis with violation of passability of the main pancreatic duct throughout without increase in the sizes of the pancreas head is conducted. Calculation of the area of anastomosis was executed according to geometric formula of fundamental mathematics taking into account their transfer on parameters of measurements of the main pancreatic duct and the pancreas as objects with a certain roughness of contours and assessment of a relative difference between indicators.
Results. Comparison of indicators of the area of anastomosis at traditional (n=22) and original (n=19) ways of a pancreaticojejunostomy showed advantage of the last one in increase in the area of anastomosis, including: an original way of a longitudinal pancreatojejunostomy with excision of a front surface of a pancreas (n=11) for 20% vs a traditional longitudinal pancreaticojejunos- tomy and repeatedly before terminoterminal (lateral) pancreaticojejunostomy; an original way of a bilateral pancreaticojejunostomy (n=4) for 14.3% vs a traditional bilateral pancreaticojejunostomy and more, than twice (127.2–128.6%) vs terminoterminal (lateral) pancreaticojejunostomy; an original way of a pancreaticojejunostomy with inclusion of the kept back surface of a pancreas, a distal and proximal stump of the main pancreatic duct (n=4) repeatedly vs other alternative ways of surgical treatment.
Conclusions. 1. Rather narrow main pancreatic duct and/or defect (diastasis) along its course is an indication to the application of the original ways of pancreatojejunostomy with expansion of anastomosis area. 2. Introduction in clinical practice of new ways of a longitudinal and bilateral pancreat(-ic)ojejunostomy allows to exclude application of more traumatic resection.
Keywords:chronic pancreatitis, main pancreatic duct, pancreas, pancreat(-ic)ojejunostomy, multispiral computerized tomography
Conflict of interest. The authors declare no conflict of interest.
For citation: Propp А.R., Degovtsov E.N., Kotenko V.V. The comparative analysis of the area of anastomosis at various options of a pancreatojejunostomy. Clin Experiment Surg. Petrovsky J. 2020; 8 (2): 58–66. DOI: 10.33029/2308-1198- 2020-8-2-58-66 (in Russian)
Received 31.05.2019. Accepted 26.03.2020.
References
1. Ni Q., Lin Y., Manish R., et al. Advances in surgical treatment of chronic pancreatitis. World J Surg Oncol. 2015; 13: 34. DOI: https://doi.org/10.1186/s12957- 014-0430-4.
2. Dennison A.R., Giuseppe G. Economic Burden of Chronic Pancreatitis and Implications of Total Pancreatectomy and Autologous Islet Cell Transplantation. JOP. 2015; 16 (5): 517–26.
3. Beger H.G., Warshaw A., Hruban R., et al The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery. Wiley-Blackwell, 2018. 1216 p.
4. Debas H.T. Gastrointestinal surgery: pathophysiology and management. New York: Springer-Verlag; 2004. 391 р.
5. Shalimov A.A., Grubnik V.V., Gorovits D., et al. Chronic pancreatitis: modern concepts of pathogenesis, diagnostics and treatment. Kiev: Zdorov'ye, 2000. 256 p. (in Russian)
6. Jawad A.R., et al. Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis. Asian J Surg. 2017; 40 (3): 179–85.
7. Forsmark C.E. Management of chronic pancreatitis. Gastroenterology. 2013; 144 (6): 1282–91.
8. Pham A., Forsmark C. Chronic pancreatitis: review and update of etiology, risk factors, and management. F1000Res. 2018; 7.
9. Polyakevich A.S., Dobrov S.M., Blagitko Е.M., et al. Comparison of the remote results of proximal resections of a pancreas at chronic. Meditsina i obrazovanie v Sibiri [Medicine and Еducation in Siberia]. 2014; 4: 13. (in Russian)
10. Vorobey A.V., Shuleyko A.Ch., Vizhinis Е.I., et al. Est the future at the draining chronic pancreatitis operations ? Systematic critical review of literature. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2016; 21 (4): 70–83. (in Russian)
11. Parkhisenko Yu.A., Zhdanov A.I., Parkhi- senko V.Yu., et al. Chronic kalkulezny pancreatitis: review of approaches to surgical. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2014; 19 (2): 91–8. (in Russian)
12. Plagemann S., Welte M., Izbicki J.R., et al. Surgi- cal Treatment for Chronic Pancreatitis: Past, Present, and Future. Gastroent Res Pract. 2017. Article ID 8418372. DOI: https://doi.org/10.1155/2017/8418372.
13. Hartmann D., Friess H. Surgical Approaches to Chronic Pancreatitis. Gastroenterol Res Pract. 2015: 1–6.
14. Kleeff J., Stöß C., Mayerle J., et al. Evidence- Based Surgical Treatments for Chronic Pancreatitis. Dtsch Arztebl Int. 2016; 113: 489–96.
15. Vallejo C., Serradilla M., Oliver J.R., et al. Partington-rochelle pancreaticojejunostomy for chronic pancreatitis: results and follow up. HPB. 2016; 18 (1): 419.
16. Parekh D., Natarajan S. Surgical Management of Chronic Pancreatitis. Indian J Surg. 2015; 77 (5): 453–69.
17. Tillou J.D., Tatum J.A., Joshua B.S., et al. Opera- tive management of chronic pancreatitis: A review. Am J Surg. 2017; 214 (2): 347–57.
18. Bapat R.D., Jadhav R.N., Mohite J.D., et al. Modi- fied Partingtons procedure for pancreaticojejunostomy in chronic pancreatitis. Indian J Gastroenterol. 1997; 16 (3): 122–5.
19. Propp A.R., Demin D.I., V'yushkov D.M., et al. Sposob of a longitudinal pankreatoyeyunostomiya with a width of the main pancreatic duct less than 5 mm. Vestnik natsional'nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova [Bulletin of Pirogov National Medical & Surgical Center]. 2011; 6 (2): 56–7. (in Russian)
20. Danilov M.V., Fyodorov V.D. Repeated and reconstructive pancreas diseases operations. Moscow: Medit- sina; 2003. 424 p. (in Russian)
21. Varabei A., Shuleika A., Vizhinis Y. et al. Chronic pacreatitis: laser technologies for double ballon enteroscopy of pancreatojejunostomy complication and peripheral ductal hypertension. J Surg. 2015; 3 (4): 32–8.
22. Klimenko A.V., Klimenko V.N., Steshenko A.A., et al. Kliniko-morfologichesky justifications the parenkhi- mosokhranyayushchikh of operations in surgery of chronic pancreatitis. Klinicheskaya khirurgiya [Clinical surgery]. 2012; 826 (1): 14–8. (in Russian)
23. Steshenko A.A. Evaluating quality of life in patients with chronic pancreatitis after surgical treatment by questionnaires EORTC QLQ-C30, EORTC QLQ-PAN28. Aktual'nyye problemy sovremennoy meditsiny: Vestnik Ukrainskoy meditsinskoy stomatologicheskoy akademii [Current Problems of Modern Medicine: Bulletin of the Ukrainian Medical Dental Academy]. 2013; 44 (13): 58–63. (in Russian)
24. Vygodsky M.Ya. Reference book on elementary mathematics. Moscow: Nauka; 1966. 424 p. (in Russian)
25. Propp A.R., Poluektov V.L. Way of a longitudinal pancreatoenteroanastomosis. Patent of the Russian Federation No. 2005106716/14, 09.03.2005. Request No. 2005106716, 09.03.2005. Patent of the Russian Federation No. 2296517. 2007. Bulletin No. 10. (in Russian)
26. Propp A.R., Poluektov V.L., Lobanov V.G. A way of a recovery stage after a medial resection of a pancreas. Request No. 2008102172, 21.01.2008. of the Russian Federation No. 2363395. 2009. Bulletin No. 22. (in Russian)
27. Propp A.R., Poluektov V.L., Nefedov I.V., et al. An original way of a recovery stage after a medial resection of a pancreas. Vestnik khirurgii imeni I.I. Grekova [Grekov's Bulletin of Surgery] 2011; 170 (1): 41–2. (in Russian)
28. Propp A.R., Poluektov V.L., Nikulina S.A. A way of a pancreatojejunostomy at a diastase between a proxi- mal and disteel stump of the main pancreatic duct. Request No. 2011100997/14, 12.01.2011. Patent of the Russian Federation No. 2460468. 2012. Bulletin No. 25. (in Russian)
29. Propp A.R., Poluektov V.L., Nikulina S.A., et al. A way of pancreatojejunostomy at a diastase between a proximal and disteel stump of the main pancreatic duct. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2013; 3: 135–40. (in Russian) https://www.elibrary.ru/item.asp?id=21020755