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Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access

2009; Thieme Medical Publishers (Germany); Volume: 41; Issue: 10 Linguagem: Inglês

10.1055/s-0029-1215081

1438-8812

Timothy P. Kinney, R. Li, Kapil Gupta, Shawn Mallery, David W. Hunter, Eric H. Jensen, Selwyn M. Vickers, Martin L. Freeman,

Gastrointestinal disorders and treatments

Whipple pancreaticoduodenectomy is an intricate surgical procedure that has traditionally carried a high morbidity and mortality. Despite advances in surgical techniques, the pancreaticojejunal anastomosis remains the "Achilles heel" of the surgery, and complications including acute duct leaks, stricturing of the pancreaticojejunostomy, and chronic pancreatic fistulae are not uncommon [1] [2] [3] [4] [5]. Acute duct leaks can often be managed conservatively with percutaneous drainage, whereas chronic strictures and fistulae may require more aggressive intervention. When re-operation and surgical revision of the pancreaticojejunal anastomosis is not possible, the only surgical option may be completion total pancreatectomy with or without islet cell autotransplantation [2] [3].