Whereabouts of an internal short stent placed across the pancreaticojejunostomy following pancreatoduodenectomy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2012-08-07

AUTHORS

Susumu Kadowaki, Fumihiko Miura, Hodaka Amano, Naoyuki Toyota, Keita Wada, Makoto Shibuya, Sawako Maeno, Tadahiro Takada, Keiji Sano

ABSTRACT

Background/PurposeIt is generally thought that an internal short stent placed across the pancreaticojejunostomy (PJ) following pancreatoduodenectomy (PD) usually passes spontaneously through the rectum thereafter; however, we experienced some patients who presented with pancreatitis and cholangitis owing to delayed defecation of the stent. The purpose of this study was to clarify when the stent eventually became detached from the PJ and how it passed through the body until it was finally defecated. In addition, we also investigated the factors that may prevent such detachment and defecation.MethodsThis study retrospectively analyzed 57 patients who had had internal short stents placed across the PJ following PD. Defecation from the body, detachment from the PJ, and distal migration of the stent was confirmed by X-ray or computed tomography (CT) during the postoperative course. The cumulative rates of defecation and detachment of the stents, complications in relation to delayed defecation of the stents, and factors predictive of the delayed defecation, delayed detachment, and distal migration of the stents were analyzed.ResultsDefecation of the stent was confirmed in 35 patients. The median time to defecation after PD and the cumulative defecation rate at 1 year were 454 days and 41 %, respectively. Acute pancreatitis occurred in 2 patients with the stent remaining in the pancreatic duct. One patient experienced acute cholangitis owing to migration of the stent to the bile duct. Multivariate analysis showed that ≥5 stitches in the duct-to-mucosa anastomosis, stent size of ≥5 Fr, and pancreatic fistula classified as either Grade B or C were independent predictive factors for delayed defecation of the stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed detachment of the stent. A stent size of ≥5 Fr was a risk factor for distal migration of the stent.ConclusionIn more than half of the study patients, internal short stents were not defecated within 1 year. Retrieval of the stent should be considered following the migration of an internal short stent. A stent size of ≥5 Fr was an independent predictive factor for delayed defecation and distal migration of a stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed defecation and detachment of a stent. More... »

PAGES

566-577

References to SciGraph publications

  • 2006-10-13. Acute Appendicitis Due to Appendiceal Obstruction from a Migrated Biliary Stent in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 2010-01-16. Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study in LANGENBECK'S ARCHIVES OF SURGERY
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  • 1998-12-01. An unusual complication of a biliary stent–small bowel perforation of an incarcerated hernia sac in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
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  • 2011-09-14. Use of pancreatic duct stents after pancreaticoduodenectomy in JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
  • 2006-02. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis in JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
  • 2007-01-30. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines in JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00534-012-0533-7

    DOI

    http://dx.doi.org/10.1007/s00534-012-0533-7

    DIMENSIONS

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    https://www.ncbi.nlm.nih.gov/pubmed/22869100


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    27 schema:description Background/PurposeIt is generally thought that an internal short stent placed across the pancreaticojejunostomy (PJ) following pancreatoduodenectomy (PD) usually passes spontaneously through the rectum thereafter; however, we experienced some patients who presented with pancreatitis and cholangitis owing to delayed defecation of the stent. The purpose of this study was to clarify when the stent eventually became detached from the PJ and how it passed through the body until it was finally defecated. In addition, we also investigated the factors that may prevent such detachment and defecation.MethodsThis study retrospectively analyzed 57 patients who had had internal short stents placed across the PJ following PD. Defecation from the body, detachment from the PJ, and distal migration of the stent was confirmed by X-ray or computed tomography (CT) during the postoperative course. The cumulative rates of defecation and detachment of the stents, complications in relation to delayed defecation of the stents, and factors predictive of the delayed defecation, delayed detachment, and distal migration of the stents were analyzed.ResultsDefecation of the stent was confirmed in 35 patients. The median time to defecation after PD and the cumulative defecation rate at 1 year were 454 days and 41 %, respectively. Acute pancreatitis occurred in 2 patients with the stent remaining in the pancreatic duct. One patient experienced acute cholangitis owing to migration of the stent to the bile duct. Multivariate analysis showed that ≥5 stitches in the duct-to-mucosa anastomosis, stent size of ≥5 Fr, and pancreatic fistula classified as either Grade B or C were independent predictive factors for delayed defecation of the stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed detachment of the stent. A stent size of ≥5 Fr was a risk factor for distal migration of the stent.ConclusionIn more than half of the study patients, internal short stents were not defecated within 1 year. Retrieval of the stent should be considered following the migration of an internal short stent. A stent size of ≥5 Fr was an independent predictive factor for delayed defecation and distal migration of a stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed defecation and detachment of a stent.
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    40 acute cholangitis
    41 acute pancreatitis
    42 addition
    43 analysis
    44 anastomosis
    45 bile duct
    46 body
    47 cholangitis
    48 complications
    49 course
    50 cumulative defecation rate
    51 cumulative rate
    52 days
    53 defecation
    54 defecation rate
    55 detachment
    56 distal migration
    57 duct
    58 experienced acute cholangitis
    59 factors
    60 fistula
    61 grade B
    62 half
    63 independent predictive factors
    64 internal short stent
    65 median time
    66 migration
    67 more stitches
    68 mucosa anastomosis
    69 multivariate analysis
    70 pancreatic duct
    71 pancreatic fistula
    72 pancreaticojejunostomy
    73 pancreatitis
    74 pancreatoduodenectomy
    75 patient experienced acute cholangitis
    76 patients
    77 postoperative course
    78 predictive factors
    79 purpose
    80 rate
    81 rays
    82 rectum
    83 relation
    84 retrieval
    85 risk factors
    86 short stents
    87 size
    88 stent size
    89 stents
    90 stitches
    91 study
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    93 such detachment
    94 time
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