Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy

Research Article

Austin J Surg. 2021; 8(1): 1263.

Initial Experience with Biodegradable Pancreatic Stents in the Prevention of Postoperative Pancreatic Fistula after Cephalic Pancreaticoduodenectomy

Sanchez-Bueno F¹*, Gil Vazquez PJ¹, Ferreras D¹, Gomez B¹, Egea-Valenzuela J² and Alberca-de las Parras F²

¹Hepatobiliopancreatic Surgery and Abdominal Transplant Unit, General and Digestive Surgery Department, Virgen de la Arrixaca University Hospital, IMIB, Murcia, Spain

²Department of Digestive Diseases, Virgen de la Arrixaca University Hospital, IMIB, Murcia, Spain

*Corresponding author: Francisco Sanchez-Bueno, Hepatobiliopancreatic Surgery and Abdominal Transplant Unit, General and Digestive Surgery Department, Virgen de la Arrixaca University Hospital, IMIB, Murcia, Spain

Received: January 27, 2021; Accepted: February 22, 2021; Published: March 01, 2021

Abstract

Background: Postoperative Pancreatic Fistula (POPF) remains the most important morbidity after pancreaticoduodenectomy. There is no consensual technique for pancreatic reconstruction and many surgeons use a transanastomotic drain. Currently, the stents used are not degradable and they can cause obstruction, stricture and pancreatitis. The use of biodegradable stents that disappear a few months after the intervention could have a role in the prevention of pancreaticojejunostomy complications. The aim of the study was to evaluate technical success of implantation and safety of newly available biodegradable stents in 16 patients undergoing cephalic duodenopancreatectomy.

Materials and Methods: A single-center prospective non-randomized study was conducted with patients undergoing PD. A total of 16 patients were included. A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (Archimedes) was placed from the pancreatic duct to the jejunum.

Results: One of the patients developed POPF, which was successfully treated with interventional radiology drainage and somatostatin analogues. Completed degradation occurred after 3 months in all cases. There was no mortality at 30 days after PD.

Conclusion: Based on our experience, the use of resorbable internal pancreatic prostheses could be a valid alternative to prevent POPF after a pancreaticoduodenectomy, also avoiding the main complications related to the use of non-absorbable prostheses.

Keywords: Pancreatic fistula; Pancreas surgery; Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancreas cancer; Pancreas surgery; Pancreatic stent

Abbreviations

POPF: Post-Operative Pancreatic Fistula; PD: Pancreaticoduodenectomy

Introduction

Pancreaticoduodenectomy (PD) is a challenge for surgeons due to the high technical demand and morbidity rate (30-50% of patients develop one or more complications). One of the most frequent complications is Postoperative Pancreatic Fistula (POPF), present in up to one third of cases [1]. Today, there is no consensual technique for pancreatic reconstruction. In order to perform this anastomosis, many surgeons use a transanastomotic drain (pancreatic internal or external stent) that facilitates the pancreatic juice drainage and keeps the pancreatic remnant permeable [2,3]. Currently, the stents used are not degradable and when these do, not migrate and get eliminated, they can cause obstruction, stricture and pancreatitis. For this reason, the use of biodegradable stents that disappear a few months after the intervention could have a role in the prevention of pancreaticojejunostomy complications. Recently, new prostheses (Archimedes stent; Amg International GmbH, Winsen, Germany) have been used in pancreatobiliary diseases to drain obstructed biliary and pancreatic ducts by endoscopy approach with promising outcomes [4,5]. The aim of the study was to evaluate technical success of implantation and safety of newly available pancreatobiliary biodegradable stents in 16 patients undergoing cephalic PD.

Materials and Methods

A single-center prospective non-randomized study was conducted with patients undergoing PD. Between May 2019 and December 2020, 16 patients were included in the study. The median age was 64 years and 93.8% were male patients. The main characteristics of the patients and pathology are summarized in (Table 1). A duct-to-mucosa end-to-side anastomosis was performed for the pancreaticojejunal anastomosis and the biodegradable stent (Archimedes) was placed from the pancreatic duct to the jejunum (Figure 1).