Phd in ADVANCED SURGICAL TECHNOLOGIES

Thesis title: GESTIONE MULTIDISCIPLINARE DELLA DEISCENZA DELL’ANASTOMOSI PANCREATICO-DIGIUNALE DOPO DUODENOCEFALOPANCREASECTOMIA: STUDIO CLINICO MONOCENTRICO

Pancreaticoduodenectomy (PD) is a highly complex surgical procedure associated with high mortality and morbidity. Although improvements in surgical techniques and postoperative care have reduced the overall mortality rate, mortality in low-volume hospitals is more than 3 times higher than in high-volume hospitals due to less surgical experience and postoperative management for complications after PD (1,3). Postoperative pancreatic fistula (POPF) is the most severe complication of PD and is associated with a risk of pseudoaneurysm, postoperative bleeding, and multiorgan failure, which can lead to death (4). Many studies have attempted to systematically evaluate risk factors for POPF and develop new anastomosis techniques or perioperative strategies to prevent it. Allen et al. reported that perioperative treatment with pasireotide is associated with a significant decrease in the incidence of this complication (5). However, these procedures cannot completely prevent POPF. Therefore, appropriate strategies must be identified to manage POPF after PD and thus reduce mortality after PD. Most cases of POPF can be managed by percutaneous drainage of the intra-abdominal fluid collection. However, this method is sometimes insufficient and can also lead to pseudoaneurysm hemorrhage, which requires life-saving surgery, such as total pancreatectomy, anastomosis repair, conversion to an alternative anastomosis, or anastomosis disconnection. The clinical management of POPF is multidisciplinary and can range from percutaneous or endoscopic drainage to surgical reintervention, which may consist of total splenopancreatectomy, repositioning or placement of an endo-Wirsung sling, raffia anastomosis, and other techniques. The purpose of this study was to evaluate our strategy for the management of grade B and C POPF after PD.