Comparative analysis of afferent loop obstruction between laparoscopic and open approach in pancreaticoduodenectomy. (1st August 2019)

• Record Type: Journal Article
• Authors: Song, Ki Byung; Yoo, Daegwang; Hwang, Dae Wook; Lee, Jae Hoon; Kwon, Jaewoo; Hong, Sarang; Lee, Jong Woo; Youn, Woo Young; Hwang, Kyungyeon; Kim, Song Cheol
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 26:Number 10(2019)
• Page Start: 459
• Page End: 466
• Publication Date: 2019-08-01
• Subjects: Afferent loop syndrome -- Comparative study -- Laparoscopy -- Pancreaticoduodenectomy -- Postoperative complications; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.656
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: Afferent loop obstruction (ALO) is a rare mechanical complication of pancreaticoduodenectomy (PD) and is associated with a high rate of morbidity and mortality. Methods: Data from patients who underwent PD between May 2007 and July 2017 at a single large‐volume center were retrospectively reviewed. Results: Of the 3, 223 patients who underwent PD, 67 developed ALO. More patients in the laparoscopic PD (LPD) group had developed ALO due to internal herniation than did those in the open PD (OPD) group (46.2 vs. 4.7%, P < 0.001). Patients in the LPD group also showed earlier occurrence of ALO (ALO occurrence within 60 days: 76.9 vs. 22.2%, P < 0.001) and more frequent requirement for surgical treatment (76.9 vs. 18.9%, P < 0.001) than did those in the OPD group. Conclusions: The characteristics of ALO were significantly different between patients who had received LPD and OPD. The most common cause of ALO in the LPD group was internal herniation occurring in the early postoperative period. Internal herniation following LPD may be prevented by routine closure of mesocolic window and should be treated by emergency surgery if it occurs. Abstract : Highlight Laparoscopic and open pancreaticoduodenectomy groups differed significantly in terms of the characteristics of afferent loop obstruction (cause, interval until diagnosis, rate of reoperation). Song and colleagues concluded that closure of the mesocolic window by suturing between the jejunal limb and mesocolon may help prevent afferent loop obstruction following laparoscopic pancreaticoduodenectomy.