Issue of pancreatodigestive anastomosis insolvency in pancreatoduodenectomy

OBJECTIVE. Evaluate the degree of the issue development, regarding insolvency of pancreato-digestive anastomosis, the development of postoperative pancreatic fistula and opportunities for early diagnosis and differentiated approach to its treatment.

MATERIALS AND METHODS. An analytical review was conducted, using PubMed medical database. Search keywords: postoperative pancreatic fistula, pancreatoduodenectomy, clinically relevant postoperative pancreatic fistula, biochemical leckage. 40 Russian and 110 foreign publications on the issue of pancreatodigestive anastomosis insolvency in the period from 2010 to 2023 were studied.

RESULTS. Postoperative pancreatic fistula is determined at the level of amylase in the discharge on peripancreatic drainage 3 times as high as the level of amylase in the blood serum on the 3^rd day after surgery. Depending on the severity and treatment tactics, there are three classes of postoperative pancreatic fistula. Shubert 10-point scale and others are taken to assess the risk of developing postoperative pancreatic fistula

DISCUSSION. Many authors note pancreatodigestive anastomosis, draining the main pancreatic duct, early removal of pancreatic drainage, the use of somatostatin analogue and options for strengthening pancreatodigestive anastomosis among major factors in preventing insolvency of pancreatodigestive anastomosis. A modified strategy of patient management with clinically significant postoperative pancreatic fistula of В class with the use of minimally invasive methods as well as pancreas-preserving methods and total pancreatectomy with the development of postoperative pancreatic fistula of C class meets many of the surgery needs at this stage. However, a significant reduction in the incidence of complications and postoperative mortality is not observed. It is shown that total pancreatectomy might be an alternative to pancreatodigestive anastomosis in carefully selected patients at high risk of postoperative pancreatic fistula, for whom the benefits of the absence of complications and early discharge from the institution exceeds the harm from complications, associated with the absence of pancreas.

CONCLUSION. The issue of pancreatodigestive anastomosis insolvency and the development of postoperative pancreatic fistula is relevant and largely unresolved. Gaining momentum multimodal and multi-disciplinary approach outlined a range of issues, underlying several realms: choosing a method of forming pancreatodigestive anastomosis; decision on draining pancreatic duct; early diagnosis of postoperative pancreatic fistula formation and differentiated approach to insolvency treatment. The issue of early and late postoperative pancreatoduodenectomy complications and postoperative pancreatic fistula, particularly, requires further analysis and experience accumulation in matters of risk assessment, preoperative preparation and postoperative management.

marine medicine, surgery, hepatopancreatobiliary surgery, pancreatoduodenal surgery, complications, insolvency of pancreatodigestive anastomosis, postoperative pancreatic fistula, pancreatectomy

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