Zusammenfassung
Die Insuffizienz der Pankreatojejunostomie bestimmt maßgeblich die Morbidität und Mortalität der Pankreaskopfresektion. Ursachen sind aggressiver Pankreassaft sowie das gehäufte Auftreten einer lokalen Pankreatitis durch Manipulation des Pankreas bei der Anastomosenanlage. Mit dem Ziel die Insuffizienzrate von bis zu 20 % zu minimieren, sind viele verschiedene Anastomosentechniken entwickelt worden. Ideal wäre eine einfache Anastomose, die unabhängig von der Weichheit des Pankreas und des Durchmessers des Pankreasgangs durchgeführt werden kann. Wir stellen drei Anastomosentechniken vor: die klassische Gang-zu-Mukosa-Pankreatojejunostomie (Cattell-Warren-Anastomose), die invaginierende Pankreatojejunostomie sowie die Blumgart-Anastomose. Anhand der verfügbaren Literatur werden die Vor- und Nachteile der einzelnen Anastomosentechniken erläutert. Die Blumgart-Anastomose sowie die invaginierende Pankreatojejunostomie scheinen der Cattell-Warren-Anastomose überlegen zu sein. Die Daten sind allerdings nicht direkt vergleichbar. Derzeit wird eine prospektiv randomisierte Studie zur Evaluation des Stellenwerts der Blumgart-Anastomose durchgeführt.
Abstract
Leakage of pancreaticojejunostomy basically determines the morbidity and mortality of pancreatic head resection. Aggressive pancreatic juice affects the integrity of the anastomosis and the occurrence of local pancreatitis is increased due to manipulation of the pancreas during creation of the anastomosis. A multitude of anastomotic techniques have been developed aimed at minimizing the leakage rate of up to 20%. Ideal would be a simple technique that can be carried out independently of the softness of the pancreas and the diameter of the pancreatic duct. We present three anastomotic techniques: the classical duct-to-mucosa pancreaticojejunostomy (Cattell-Warren anastomosis), the invagination pancreaticojejunostomy and the Blumgart anastomosis. Based on the available literature, the advantages and disadvantages of each technique are explained. The Blumgart anastomosis and the invagination pancreaticojejunostomy seem to be superior to the Cattell-Warren anastomosis; however, the available data cannot be directly compared. Currently, a prospective randomized study is being conducted to evaluate the importance of the Blumgart anastomosis.
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F.C. Popp und C.J. Bruns geben an, dass kein Interessenkonflikt besteht.
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Popp, F.C., Bruns, C.J. Variationsbreite der Pankreatojejunostomie bei Pankreaskopfresektion. Chirurg 88, 3–10 (2017). https://doi.org/10.1007/s00104-016-0327-6
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DOI: https://doi.org/10.1007/s00104-016-0327-6