Pancreatic Ducts Obliteration With Controlled Injection of Onyx®: A Proposal of New Onyx® Pancreatic Ducts Obliteration Scoring System. (April 2023)

• Record Type: Journal Article
• Authors: Crafa, Francesco; Vanella, Serafino; Noviello, Adele; Lombardi, Giulio; Coppola Bottazzi, Enrico
• Is Part Of: Surgical innovation. Volume 30:Number 2(2023)
• Page Start: 201
• Page End: 204
• Publication Date: 2023-04
• Subjects: pancreatic duct occlusion -- pancreaticoduodenectomy -- post-operative pancreatic fistula -- onyx -- periampullary cancers; Surgery, Operative -- Periodicals; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Diffusion of Innovation -- Periodicals; Chirurgie opératoire -- Périodiques; Chirurgie endoscopique -- Périodiques; Chirurgie laparoscopique -- Périodiques; 617.91
• DOI: 10.1177/15533506221120148
• Languages: English
• ISSNs: 1553-3506

Abstract

Background: The aim of this study was confirm the efficacy and feasibility of Onyx injection for pancreatic stump management after pancreaticoduodenectomy (PD) and investigate a new Onyx ® Pancreatic Ducts Obliteration (OPDO) scoring system of pancreatic duct obliteration (PDOb) in patients with high risk of Post-Operative Pancreatic Fistula (POPF). Study Design: We enrolled ten patients undergoing PDOb with Onyx ® intraoperative controlled injection after elective PD. Results: PDOb with Onyx ® controlled injection was classified according to the OPDO scoring system in three degrees: complete 5/10 (50%), medium 2/10 (20%) and bad 3/10 (30%). Increased amylase in abdominal drainage was identified in two patients (20%) with a degree II and III, and resolved spontaneously within a week. A "clinically relevant" POPF (CR-POPF) was observed in one patient (10%) with a degree III and none in the patients with degree I and II. Discussion: We confirm that intraoperative injection of Onyx ® is a valid solution in high-risk POPF patients and our OPDO scoring system allows obtain an intraoperative classification of the degree of PDO to prevent the CR-POPOF; furthermore, it may be suggested that the viscosity of the injected product (Onyx ® ) reduce parenchymal fibrosis.