The fast-track surgery program application after pancreaticoduodenectomy, using interintestinal anastomosis in accordance to Brown procedure

Keywords: pancreaticoduodenectomy; program of accelerated restoration; anastomosis in accordance to Brown procedure.

Abstract

Objective. To estimate the impact of formation of gastroenteroanastomosis with Brown’s anastomosis, while performing of pancreatico-duodenectomy, on the gastric evacuation arrest rate in a frame of the fast-track surgery program implementation.

Materials and methods. To the investigation 92 patients, ageing 28 -75 yrs old, were included, to whom pancreaticoduodenectomy for benign and malignant pancreatic and peripancreatic zone pathology was performed in Jan. 2015 - Aug. 2020 yrs. Perioperative treatment was conducted in accordance to the fast-track surgery program. The first Group consisted of 60 patients, in whom reconstruction in accordance to Child was done, and the second Group - of 32 patients, in whom gastroenterostomy with anastomosis in accordance to Brown procedure was performed.

Results. In the Group I complications have had occurred in 16 (26.7%) patients, in the Group II - in 7 (21.9%), in Group I there were 22 complications, in the Group II - 10, but trustworthy difference between the Groups in accordance to these indices was absent (p > 0.05). Analysis of parameters for restoration of peroral feeding have shown enhanced susceptibility of the program in patients of Group II. The rate of the gastric evacuation arrest in first Group of patients have exceeded the analogous index in patients of Group II in 2 times - 13.3 and 6.3%, accordingly, but statistically significant difference between the Groups in accordance to this index was absent (p = 0.299).

Conclusion. While formation of gastroenteroanastomosis with anastomosis in accordance to Brown procedure in pancreatico-duodenectomy the implementation level for the fast-track surgery program raises and the rate of gastric evacuation arrest diminishes.

Author Biographies

O. Yu. Usenko, Shalimov National Institute of Surgery and Transplantology, Kyiv

Usenko Olexandr Yu., MD, DSci(Med), Professor;
Director of the Shalimov National Institute of Surgery and Transplantology,
Head of the department of Thoracoabdominal Surgery;
Kyiv, 30 Heroiv Sevastopolia str.
+38 (044) 454 70 50
ausenko1962@gmail.com
https://orcid.org/0000-0003-4957-4104

A. A. Skums, Shalimov National Institute of Surgery and Transplantology, Kyiv

Skums Anatolii A., MD, Surgeon
Department of surgery of retroperitoneal pathology and combined pathology
Shalimov National Institute of Surgery and Transplantology, Kyiv,
30 Heroiv Sevastopolia str., Kyiv, Ukraine
https://orcid.org/0000-0002-3477-7809

References

Glowka TR, Webler M, Matthaei H, Schäfer N, Schmitz V, Kalff JC, et al. Delayed gastric emptying following pancreatoduodenectomy with alimentary reconstruction according to Roux-en-Y or Billroth-II. BMC Surg. 2017 Mar 20;17(1):24. doi: 10.1186/s12893-017-0226-x. PMID: 28320386; PMCID: PMC5359898.

Gahagan JV, Hanna MH, Moghadamyeghaneh Z, Alizadeh RF, Nguyen A, Yamamoto M, et al. Risk factors, timing of complications and readmission after pancreaticoduodenectomy. Gastroenterol Pancreatol Liver Disord. 2018;6(2):1-7. doi: 10.15226/2374-815X/6/2/001121.

Wang WG, Babu SR, Wang L, Chen Y, Tian BL, He HB. Use of Clavien-Dindo classification in evaluating complications following pancreaticoduodenectomy in 1,056 cases: A retrospective analysis from one single institution. Oncol Lett. 2018 Aug;16(2):2023-9. doi: 10.3892/ol.2018.8798. Epub 2018 May 24. PMID: 30008896; PMCID: PMC6036274.

Jung JP, Zenati MS, Dhir M, Zureikat AH, Zeh HJ, Simmons RL, et al. Use of Video Review to Investigate Technical Factors That May Be Associated With Delayed Gastric Emptying After Pancreaticoduodenectomy. JAMA Surg. 2018 Oct 1;153(10):918-27. doi: 10.1001/jamasurg.2018.2089. PMID: 29998288; PMCID: PMC6584315.

Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997 May;78(5):606-17. doi: 10.1093/bja/78.5.606. PMID: 9175983.

Kagedan DJ, Ahmed M, Devitt KS, Wei AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB (Oxford). 2015 Jan;17(1):11-6. doi: 10.1111/hpb.12265. Epub 2014 Apr 18. PMID: 24750457; PMCID: PMC4266435.

Aleassa EM, Anzlovar N, Stiff GM. Single-institution outcomes of enhanced recovery after surgery protocol implementation in pancreaticoduodenectomy. JACS. 2018 Oct 1;227(4 Suppl 1):S181. doi: 10.1016/j.jamcollsurg.2018.07.385.

Klaiber U, Probst P, Knebel P, Contin P, Diener MK, Büchler MW, et al. Meta-analysis of complication rates for single-loop versus dual-loop (Roux-en-Y) with isolated pancreaticojejunostomy reconstruction after pancreaticoduodenectomy. Br J Surg. 2015 Mar;102(4):331-40. doi: 10.1002/bjs.9703. Epub 2015 Jan 29. PMID: 25644428.

Fujieda H, Yokoyama Y, Hirata A, Usui H, Sakatoku Y, Fukaya M, et al. Does Braun Anastomosis Have an Impact on the Incidence of Delayed Gastric Emptying and the Extent of Intragastric Bile Reflux Following Pancreatoduodenectomy? - A Randomized Controlled Study. Dig Surg. 2017;34(6):462-8. doi: 10.1159/000455334. Epub 2017 Jan 28. PMID: 28132059.

Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012 Dec;31(6):817-30. doi: 10.1016/j.clnu.2012.08.011. Epub 2012 Sep 26. PMID: 23079762.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5): 761-8. doi: 10.1016/j.surg.2007.05.005.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017 Mar;161(3):584-91. doi: 10.1016/j.surg.2016.11.014. Epub 2016 Dec 28. PMID: 28040257.

Pineda-Solis K, Ruffolo LI, Linehan DC, Schoeniger LO, Galka E. Enhanced recovery after surgery protocol in pancreatic surgery, critical factors for rapid patient recovery. HPB. 2019 March 01;21(Suppl 1):S161. doi:10.1016/j.hpb.2019.03.291.

Williamsson C, Karlsson T, Westrin M, Ansari D, Andersson R, Tingstedt B. Sustainability of an enhanced recovery program for pancreaticoduodenectomy with pancreaticogastrostomy. Scand J Surg. 2019; 108(1):17-22. doi: 10.1177/1457496918772375. PMID: 29756520.

Xu B, Meng H, Qian M, Gu H, Zhou B, Song Z. Braun enteroenterostomy during pancreaticoduodenectomy decreases postoperative delayed gastric emptying. Am J Surg. 2015 Jun;209(6):1036-42. doi: 10.1016/j.amjsurg.2014.06.035. Epub 2014 Oct 13. PMID: 25457234.

Zhou Y, Hu B, Wei K, Si X. Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis. BMC Gastroenterol. 2018 Nov 26;18(1):176. doi: 10.1186/s12876-018-0909-5. PMID: 30477442; PMCID: PMC6258435.

Huang MQ, Li M, Mao JY, Tian BL. Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis. Int J Surg. 2015 Nov;23(Pt A):75-81. doi: 10.1016/j.ijsu.2015.09.038. Epub 2015 Sep 16. PMID: 26384836.

Hwang HK, Lee SH, Han DH, Choi SH, Kang CM, Lee WJ. Impact of Braun anastomosis on reducing delayed gastric emptying following pancreaticoduodenectomy: a prospective, randomized controlled trial. J Hepatobiliary Pancreat Sci. 2016 Jun;23(6):364-72. doi: 10.1002/jhbp.349. Epub 2016 Apr 24. PMID: 27038406.

Published
2020-10-29
How to Cite
Usenko, O. Y., & Skums, A. A. (2020). The fast-track surgery program application after pancreaticoduodenectomy, using interintestinal anastomosis in accordance to Brown procedure. Klinicheskaia Khirurgiia, 87(9-10), 3-8. https://doi.org/10.26779/2522-1396.2020.9-10.03
Section
General Problems of Surgery