THE CHOICE OF PANCREATOJEJUNO-ANASTOMOS TECHNIQUE FOR PANCREATO-DUODENAL RESECTION
Summary. Objective. Development of an algorithm for choosing the method of pancreatojejunoanastomosis in pancreatoduodenal resection, taking into account the degree of change in the pancreatic parenchyma.
Materials and methods. Pancreatoduodenal resection was performed on 291 patients with obstructive diseases of the pancreatoduodenal zone. Three options were used for pancreatojejunoanastomos: invagination ductopancreatojejunal — in 210 (72.4 %), invagination pancreatojejunal — in 68 (23.4 %), pancreatojejunal with bandage repair of the crescent ligament of the liver — in 13 (4.4 %) patients.
Results. The pancreatic parenchyma was assessed by the following factors: puffiness, infiltration, obesity, degree of pancreatic parenchyma fibrosis, location and diameter of the Wirsung duct. High and low risk factors for the development of pancreatic fistula were identified. Diagnosis of pancreatic fistula was carried out according to the classification of ISGPF (2016). A differentiated approach was applied to the choice of pancreatojejunoanastomosis depending on the degree of changes in the pancreatic parenchyma, the diameter and location of the Wirsung duct.
Conclusion. Evaluation of the degree of pancreatic parenchyma changes, the diameter and location of the Wirsung duct allows you to choose the optimal technique for pancreatojejunoanastomosis in pancreatoduodenal resection. The use of a differentiated approach to the choice of pancreatojejunoanastomosis technique for pancreatoduodenal resection, taking into account the degree of change in the pancreatic parenchyma, can reduce the incidence of PF (type B, C).
2. Mushenko EV., Bojko V.V., Tishhenko AM., Smachilo RM., Ivanova YuV. Uluchshenie neposredstvenny`kh rezul`tatov pankreatoduodenal`noj rezekczii. Klinicheskaya khirurgiya. 2019.86 (8):3-8. [In Ukrainian].
3. Patyutko YuI., Kotel`nikov AG., Polyakov AN., Podluzhny`j DV. E`volyucziya khirurgii raka golovki podzheludochnoj zhelezy` i periampulyarnoj zony`. Annaly` khirurgicheskoj gepatologii. 2019;24(3):45-53. [In Ukrainian].
4. Hara K., Yamao K., Mizuno N., Hijioka S., Imaoka H., Tajika M. et al. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how? World J. Gastroenterol. 2016; 22 (3): 1297–1303.