Evidence map›Paper›PMID 36879165›Full record

ArticleSurgical endoscopy2023

Internal drainage for interdisciplinary management of anastomotic leakage after pancreaticogastrostomy.

Matthäus Felsenstein, Ann-Christin Amini, Sophie Dorfer, Mengwen Hu, Ruonan Wang, Lea Timmermann, Karl Herbert Hillebrandt, Christian Benzing, Uli Fehrenbach, Uwe Pelzer and 4 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
1.2field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 5 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 2 institutions in 1 country.

Matthäus FelsensteinDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany. matthaeus.felsenstein@charite.de.ORCID 0000-0003-3146-8717
Ann-Christin AminiDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Sophie DorferDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Mengwen HuDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Ruonan WangDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Lea TimmermannDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Karl Herbert HillebrandtDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Christian BenzingDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Uli FehrenbachDepartment of Radiology, CCM | CVK, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Uwe PelzerDivision of Hematology, Oncology and Tumor Immunology, Medical Department, CCM, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Igor Maximillian SauerDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Johann PratschkeDepartment of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Christian Jürgensen *Department of Hepatology and Gastroenterology, CCM | CVK, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Thomas Malinka *Department of Surgery, CCM | CVK, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
Humboldt-Universität zu Berlin · DECharité - Universitätsmedizin Berlin · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnastomotic leakage and postoperative pancreatic fistula (POPF) may occur after pancreatic head resection, also in the setting of pancreato-gastric reconstruction. For adequate complication management, a variety of non-standardized treatments are available. Still, data on clinical evaluation of endoscopic methods remain scarce. Based on our interdisciplinary experience on endoscopic treatment of retro-gastric fluid collections after left-sided pancreatectomies, we developed an innovative endoscopic concept with internal peri-anastomotic stent placement for patients with anastomotic leakage and/or peri-anastomotic fluid collection.

methodsOver the period of 6 years (2015-2020) we retrospectively evaluated 531 patients after pancreatic head resections at the Department of Surgery, Charité-Unversitätsmedizin Berlin. Of these, 403 received reconstruction via pancreatogastrostomy. We identified 110 patients (27.3%) with anastomotic leakage and/or peri-anastomotic fluid collection and could define four treatment groups which received either conservative treatment (C), percutaneous drainage (PD), endoscopic drainage (ED), and/or re-operation (OP). Patients were grouped in a step-up approach for descriptive analyses and in a stratified, decision-based algorithm for comparative analyses. The study's primary endpoints were hospitalization (length of hospital stay) and clinical success (treatment success rate, primary/secondary resolution).

resultsWe characterized an institutional, post-operative cohort with heterogenous complication management following pancreato-gastric reconstruction. The majority of patients needed interventional treatments (n = 92, 83.6%). Of these, close to one-third (n = 32, 29.1%) were treated with endoscopy-guided, peri-anastomotic pigtail stents for internal drainage as either primary, secondary and/or tertiary treatment modality. Following a decision-based algorithm, we could discriminate superior primary-(77,8% vs 53.7%) and secondary success rates (85.7% vs 68.4%) as well as earlier primary resolutions (11.4 days, 95%CI (5.75-17.13) vs 37.4 days, 95%CI (27.2-47.5)] in patients receiving an endoscopic compared to percutaneous management.

conclusionThis study underscores the importance of endoscopy-guided approaches for adequate treatment of anastomotic leakage and/or peri-anastomotic fluid collections after pancreatoduodenectomy. We herein report a novel, interdisciplinary concept for internal drainage in the setting of pancreato-gastric reconstruction.

Indexed as

Anastomotic LeakPancreasDrainageEndoscopy, GastrointestinalHumansPostoperative ComplicationsRetrospective StudiesStentsTreatment OutcomeAnastomotic leakageEndoscopy-guided drainageIntramural drainagePancreatic fistulaPeri-anastomotic stent

Identifiers

PMID36879165
PMCPMC10322762
OpenAlexW4323309557

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.