Jornal de Hepatologia e Distúrbios Gastrointestinais
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Duodenum-Pancreatectomy with Pancreatic Abandonment, Report of the First Case of This Technique in Ecuador

MedinaDG,GordilloVR,QuingaVM,AngosMV,DanielaGA

The incidence of malignant tumors of the pancreas has increased in countries of the Asian continent and in Western nations, the mortality of radical respective surgery of the pancreas is less than 3%, the postoperative pancreatic fistula is present in 10%, the associated mortality the development of a post-surgical pancreatic fistula can reach up to 40% 4-5-6-7. We present a clinical case of a patient with adenocarcinoma of the head of the pancreas in which a variant of the classic technique was applied, “leaving” the distal pancreas. A 70-year-old male patient, diabetic and hypertensive, who presents with abdominal pain and jaundice, a laboratory confirms an obstructive cholestasis pattern, a tomography shows adenocarcinoma of the head of the pancreas, a Whipple procedure was performed and it was decided not to perform a jejunal pancreatic anastomosis by placing a surgical sealant patch. In pancreatic remnant, the patient develops a fistula at 7 days of low output that responds to clinical management and closure of the same at 40 days. Pancreatic fistula in pancreatic duodenectomy is associated with high morbidity and mortality, several techniques have been described to avoid its appearance with variable results and clinical management through the use of somatostatin analogues does not show a protective effect. The use of fibrin sealants as glue or as a patch was described has been described by several authors, where the incidence of fistula did not decrease, many of these series report the use of glue as an adjuvant to the anastomosis, in our case we opted for Dispense with the anastomosis and seal the pancreatic remnant with a fibrin patch, taking as reference the work presented by Marczell in 1992, performing a risk-benefit analysis between a pancreatic leak with or without anastomosis, we can tip the balance and generate the hypothesis that a patient who develops a postoperative fistula without pancreatic anastomosis will have a better outcome. The use of hemostatic sealants shows certain benefits in hepatobiliary and pancreatic surgery, in our case they did not prevent the development of a fistula, but by “leaving” the pancreas, the evolution and control of the fistula did not cause major complications, which are very common when it appears. With the classical technique.