The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury

Abstract

Pancreatic trauma is associated with high mortality and morbidity, especially in main pancreatic duct (MPD) injuries. Here, we introduce a novel technique via the placement of bridge stenting-based internal drainage (BSID) along the injured MPD to restore pancreatic tissue integrity. Twelve patients with MPD injury underwent unobstructed BSID as physical support for healing. Six patients with peripheral organ injuries underwent operative end-to-end anastomosis of the MPD by using a polyurethane central venous catheter for the BSID, and the other six patients with isolated proximal MPD rupture received BSID via endoscopic pancreatic stent placement. The BSID technique was successfully performed in all pancreatic trauma patients without the need for a second open surgery. With this simplified BSID-based operation, a short procedure duration (242.7 ± 38.71 min in the surgical group and 100.2 ± 16.24 min in the endoscopic group) and a short hospital stay (13.0 ± 7.05 days) were achieved. However, a few complications (41.67%) still occurred, including pancreatitis, fistula, abscess, pseudocyst, cholangitis, and haemorrhage. Except for the deceased case, all postoperative courses were marked by decreases in the peripancreatic fluid collection, blood amylase recovery, and normal endocrine function. The BSID approach is a feasible surgical approach for the treatment of MPD injury and can be used endoscopically in isolated MPD injuries for its safety and convenience.

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Acknowledgements

We sincerely thank the critical revisions by Professor Nalu Navarro-Alvarez from the College of Medicine, Harvard Medical School, and give thanks to Mr. Kai-jiong Li in beautifying the schematic diagrams for this manuscript. This work was partially supported by Foundation for National Clinic Key Construction Speciality (no. PTWK2016-CMGH), Natural Science Foundation of China (no. 81302168), and Scientific Foundation of Chengdu Medical College (no. CYZ19-07).

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Correspondence to Hong-tao Yan or Wei-hui Liu.

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This study was performed in accordance with clinical study protocols and the principles of the Declaration of Helsinki (modified 2000) and was approved by the Research Care and Ethics Committee at our institution (No. SPPHCT2019–0901).

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Wen, X., Liu, D., Zhang, B. et al. The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury. Updates Surg (2020). https://doi.org/10.1007/s13304-020-00807-5

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Keywords

  • Pancreatic trauma
  • Main pancreatic duct injury
  • Bridge stenting-based internal drainage
  • Endoscopic surgery
  • Pancreatic surgery