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Preemptive endoluminal vacuum therapy after pancreaticoduodenectomy: A case report

BACKGROUND: Pancreaticoduodenectomy is a technically demanding operation, with reported morbidity rates of approximately 40%–50%. A novel idea is to use endoscopic vacuum therapy (EVT) in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas. In a recent case series, EVT was pr...

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Detalles Bibliográficos
Autores principales: de Medeiros, Flaubert Sena, do Monte Junior, Epifanio Silvino, França, Romero de Lima, de Medeiros Neto, Heli Clóvis, Santos, Juliany Medeiros, Almeida Júnior, Eligio Alves, da Silva Júnior, Samuel Oliveira, Tavares, Mario Herman Santos Moura Pedreira, de Moura, Eduardo Guimarães Hourneaux
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677886/
https://www.ncbi.nlm.nih.gov/pubmed/33269058
http://dx.doi.org/10.4253/wjge.v12.i11.493
Descripción
Sumario:BACKGROUND: Pancreaticoduodenectomy is a technically demanding operation, with reported morbidity rates of approximately 40%–50%. A novel idea is to use endoscopic vacuum therapy (EVT) in a preemptive setting to prevent anastomotic leakage and pancreatic fistulas. In a recent case series, EVT was proven to be effective in preventing leaks in patients with anastomotic ischemia. There have been no previous reports on preemptive EVT after pancreaticoduodenectomy. CASE SUMMARY: We describe the case of a 71-year-old woman with hypertension and diabetes who was admitted to the emergency room with jaundice, choluria, fecal acholia, abdominal pain, and fever. Admission examinations revealed leukocytosis and hyperbilirubinemia (total: 13 mg/dL; conjugated: 12.1 mg/dL). Abdominal ultrasound showed cholelithiasis and dilation of the common bile duct. Magnetic resonance imaging demonstrated a stenotic area, and a biopsy confirmed cholangiocarcinoma. Considering the high risk of leaks after pancreatico-duodenectomy, preemptive endoluminal vacuum therapy was performed. The system comprised a nasogastric tube, gauze, and an antimicrobial incise drape. The negative pressure was 125 mmHg, and no adverse events occurred. The patient was discharged on postoperative day 5 without any symptoms. CONCLUSION: Preemptive endoluminal vacuum therapy may be a safe and feasible technique to reduce leaks after pancreaticoduodenectomy.