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The authors describe the technique to perform a mechanical biliodigestive anastomosis after pancreatoduodenectomy that could be able to reduce the time of surgical intervention and the major systemic postoperative complication especially in elderly patients. Pancreaticoduodenectomy (PD) is considered to be the most effective procedure for the treatment of tumors of the pancreatic head and periampullary tumors. Postoperative morbidity remains high, reaching 40-50% in some series. Leakage and stricture of hepaticojejunal anastomosis have a special significance and occur in 2.5-5% of cases. The usefulness of mechanical staplers is well established in gastric and colorectal surgery, but their use in creating biliodigestive anastomosis is still a very controversial application. In the last 2 years (Nov 2008-Nov 2010), seven patients who underwent PD and presented at the time of operation, a main bile duct (MBD) greater of 20 mm, received a mechanical biliodigestive anastomosis with surgical stapler. All the patients were postoperatively controlled with an ultrasonography at 3 and 6 months, and a cholangio MRI at 1 year from operation. The follow up of the seven patients ranged from 3 to 18 months. Six patients are still alive and free of oncologic disease. One patient presented a single episode of cholangitis with a significant reduction of caliber of the biliodigestive anastomosis. The remaining five patients showed a good caliber of hepaticojejunal anastomosis. The authors suggest this procedure as a safe, feasible, more rapid and easier technique than traditional suture for bilioenteric anastomosis, when a suitable caliber of MBD allows to perform it.
Department of Surgery, UOC General and Oncological Surgery, AORN "S. Camillo-Forlanini", Rome, Italy.
This article was published in the following journal.
Name: Updates in surgery
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A device, activated electronically or by expired pulmonary air, which simulates laryngeal activity and enables a laryngectomized person to speak. Examples of the pneumatic mechanical device are the Tokyo and Van Hunen artificial larynges. Electronic devices include the Western Electric electrolarynx, Tait oral vibrator, Cooper-Rand electrolarynx and the Ticchioni pipe.
A Y-shaped surgical anastomosis of any part of the digestive system which includes the small intestine as the eventual drainage site.
Removal of a MEDICAL DEVICE from the market due to the identification of an intrinsic property of the device that results in a serious risk to public health.
A vessel that directly interconnects an artery and a vein, and that acts as a shunt to bypass the capillary bed. Not to be confused with surgical anastomosis, nor with arteriovenous fistula.
The removal of a circular disk of the cranium. It is performed with a trephine, a small circular saw with a center pin mounted on a hollow metal shaft to which is attached a transverse handle. (Random House Unabridged Dictionary, 2d ed)
Pancreatitis Acute pancreatitis is inflammation of the pancreas caused by the release of activated pancreatic enzymes. Common triggers are biliary tract disease and chronic heavy alcohol intake. Diagnosis is based on clinical presentation...