Endoscopic Intervention can Prevent Reoperation in Patients after Pancreas Transplantation – The Advantage of the Duodenoduodenal Anastomosis
Katarzyna Baumgart-Gryn1,2, Marek Durlik1,2.
1Clinical Dpt of Gastroenterological Surgery and Transplantation, Central Clinical Hospital of The Ministry of The Interior and Administration, Warsaw, Poland; 2Dpt. Of Surgical Research and Transplantology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
Introduction: Since the first pancreas transplantation in 1966, surgical techniques have vastly evolved. Nowadays, in most transplant centres, the preferred type of anastomosis is the one with the small intestine. However, when the duodenoduodenal anastomosis was introduced, it has become a highly beneficial type of anastomosis and is now routinely performed in our Centre.
Materials and Methods: We performed 193 pancreas transplantations since 2004 until September 2017. Among these patients we performed 164 duodenoduodenal and 29 duodenojejunal anastomoses.
Results: Among all 164 patients with duodenoduodenal anastomosis 141 were Simultaneous Pancreas Kidney transplantations (SPK), 21 Pancreas Transplantations Alone (PTA) and 2 Pancreas After Kidney (PAK) transplantations. Endoscopic intervention due to anastomotic bleeding was necessary in 32 cases. Only in one case it wasn’t successful and the patient had to be reoperated. In group of patients with duodenojejunal anastomosis the reoperation due to GI bleeding was necessary in 2 patients.
Conclusion:Duodenoduodenal anastomosis is a safe option of enteric drainage that provides many advantages. It enables easy, non-invasive endoscopic access to the transplanted duodenum and possible intervention in case of GI bleeding.
