Purpose: To present the efficacy and feasibility of preoperative percutaneous pancreatic duct drainage (PPDD) for patient pre-surgery preparation and post-surgery safety improvement of pancreatojejunal anastomosis
Material and Methods: Both percutaneous transhepatic biliary derainage (PTBD) and pancreatic duct drainage (PPDD) has been performed to 4 patients (3 – cancer of the head of pancreas, 1-Papilla of Vater tumor) with biliary and PD obstruction for pre-operative improvement of the liver and pancreas functional status. The drains also were intended to be used as preventive measure, enabling to percutaneously manage possible biliary or pancreatic leakage complications after resection. PTBD was performed using conventional US&Fluoroscopy guided technique; the same approach was applied in 3 PPDD cases; in the 4th case CT&fluoroscopy guidance has been used. Pancreatojejunostomy was performed in 2-3 weeks after PTBD and PPDD using novel double invagination technique for pancreatic anastomosis formation. During surgery pancreatic drain was used to form transanastomotic percutaneous stent.
Results: Pre-surgery PTBD and PPDD enabled to stabilize the liver and pancreas functional status, alleviating the jaundice, chiolangitis, pancreatitis and pancreatic atrophy related diabetes. There was no PPDD related complications detected. Drainage catheters were withdrawn after anastomosis consistency check by contrast injection via biliary and pancreatic duct drains in 2-3 weeks after surgery. No biliary or pancreatic leakage was detected in this cohort.
Conclusions: PPDD performed 2-3 weeks before surgery, prepares patient for surgery by alleviation of pancreatitis and pancreatic atrophy related diabetes. Futhermore, PPDD kept in post-surgery period provides the possibility to manage the leakage by covered stent percutaneous implantation. The rationale of PPDD before pancreatoduodenectomy is similar to such of PTBD intervention. As the pancreatic fistula is a leading cause of morbidity and mortality after pancreatoduodenectomy, PPDD should be routinely suggested on MDT discussion as a possible preparatory treatment option on pancreatoduodenal resection curative treatment planning.