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Introduction: Treatment of severe pancreatic injuries is usually surgical resection; however, preserving the organ should be a priority. The objective of this study was to propose an alternative primary suturing approach to pancreatic transfixant injuries and to describe the early outcomes of patients treated at a level 1 Trauma Center. Methods: Descriptive study of patients with pancreatic trauma surgically treated at our institution between 2012 and 2022. Clinical characteristics, severity according to the AAST classification, clinical outcomes, and mortality were analyzed. Results: 107 patients were included, 84% men, with median age of 25 years (IQR 19-32) and ISS of 25 (IQR 13-41). 82% (n=89) had penetrating trauma. Pancreatic lesions were grade I in 32 (30%) patients, grade II in 43 (40%), grade III in 28 (26%), grade IV in 3 (3%), and grade V in 1 (1%). Primary suturing was performed in 44 (41%) patients and pancreatectomy in 15 (14%). The incidence of of postoperative fistula among patients treated with suture was 33.3% (n=4) and 43% (n=6) with pancreatectomy. One pancreatectomy patient presented with diabetes at discharge (1%). In-hospital mortality rate was 10.2% (n=11). Conclusion: Management of pancreatic trauma with primary suturing is a viable and safe option. In our cohort, the organ was preserved in almost half of the patients with severe injuries, without increasing the rate of fistulas. [ABSTRACT FROM AUTHOR]

Introduction. Postoperative pancreatic fistula is one of the most important complications in hepatobiliopancreatic surgery. Its diagnosis is made by the presence of an amylase level in the drainage fluid at least three times above the serum amylase value from the third postoperative day. The objective of this study was to characterize patients with postoperative pancreatic fistula at our institution, evaluating the importance of early detection and to establish a timely management. Methods. Descriptive, retrospective study that included patients who underwent pancreatoduodenectomy with a diagnosis of postoperative pancreatic fistula as a complication of hepatobiliopancreatic surgery at the Hospital Internacional Colombia, between January 2017 and December 2020. Patients with another type of procedure performed by this specialty and those who did not decide to participate in the study were excluded. Results. A total of 69 patients were included, the median age was 57 years with a predominance of females (n=38; 55.1%). 33.3% (n=24) of the operated patients developed postoperative pancreatic fistula, with 23.2% having a biochemical leak, grade B in 8.7% and grade C in 2.9%, for whom expectant management, ultrasound control and reintervention were indicated, respectively. Five patients died (7.2%). Conclusions. Pancreatic fistula is a complication to take into account in all patients undergoing pancreatoduodenectomy. There are strategies that can reduce the incidence of this complication and thus improve not only the outcome but also the prognosis and postoperative morbidity. [ABSTRACT FROM AUTHOR]

Entre las complicaciones más raras e infrecuentes de pancreatitis crónica se ubican las fístulas pancreáticas-pleurales, estas se presentan en un 0.04% de la población con esta comorbilidad. Se describe un caso clínico de un masculino de 59 años con antecedente de pancreatitis aguda a repetición, quien inicia con cuadro de dificultad respiratoria aguda de 2 meses de evolución asociado con derrame pleural izquierdo masivo. Se realiza toracocentesis para drenar aproximadamente 2500 ml de líquido de tipo exudativo y, además, se evidencia coinfección por pseudomona putida en cultivo de líquido pleural, la cual se cubre con meropenem 500 mg cada 8 horas IV por 14 días. Posteriormente, se realiza una tomografía axial computarizada (TAC) abdominal sin medio de contraste intravenoso que evidencia pseudoquiste pancreático y colangiopancreatoresonancia (CPRE) que exhibe un pancreatograma anormal con fuga de medio de contraste entre cabeza y cola pancreática por lo que se colocó stent en vía pancreático-biliar.

Introducción: La pancreaticoduodenectomía cefálica es uno de los procedimientos de mayor complejidad técnica de la cirugía general. La principal causa de morbilidad de esta operación y la más peligrosa es la fístula pancreática posoperatoria. Objetivo: Caracterizar a los pacientes con fístula pancreática pospancreaticoduodenectomía cefálica. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo en el Servicio de Cirugía Hepatobiliopancreática del Centro de Investigaciones Médico-Quirúrgicas, entre los años 2008 y 2020. Se tomó como población a 54 pacientes que fueron tratados con pancreaticoduodenectomía cefálica y como muestra no probabilística y por conveniencia 12 casos que presentaron fístula pancreática posoperatoria. Se utilizaron técnicas de estadística descriptiva para el cálculo de las frecuencias absolutas, porcentajes, media, valores extremos y desviación estándar. Resultados: La fístula pancreática posoperatoria se presentó con una frecuencia del 22,2 % del total de pacientes operados. La edad media fue de 61 años, predominaron los pacientes del sexo masculino con una relación entre ambos sexos de 1:2. El Tipo A y el B fueron los más frecuentes con 5 casos cada uno y las fístulas pancreáticas postoperatorias con significación clínica se presentó en un 58,4 % de los casos. Conclusiones: Los pacientes se caracterizan por tener una edad media mayor de 60 años, en su mayoría hombres. Pocos casos presentaron fístulas con cuadro clínicos graves. No se observa esta complicación en los pacientes tratados por enfermedad benigna.

Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the viable upstream pancreatic parenchyma and the gastrointestinal tract, generally caused by ductal necrosis after severe acute necrotizing pancreatitis. This compromised ductal integrity leads to extraductal leakage of pancreatic secretions, causing a prolonged disease course and complications. The existing literature is limited, with unclear therapeutic algorithms. We have performed a review of the literature on DPDS. Review in Pubmed and Scielo (2011-2021) of articles in English and Spanish using the terms “disconnected pancreatic duct syndrome”, “DPDS” and “disconnected pancreas” finding 16 relevant articles. Given the few citations, the references of these articles was reviewed. Finally, we found 21 articles. Among them, there is one meta-analysis, 4 prospective studies and no randomized trials. [ABSTRACT FROM AUTHOR]

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A total of six patients with pancreatic ductal disruption (PDD), treated with image-guided endoscopy percutaneous drainage were enrolled. Initially, patients had infected pancreatic necrosis, treated with transgastric percutaneous drainage, and after the infection was controlled, they developed PDD. In the imaging study process, four patients were diagnosed with partial duct disruption and two patients with complete duct disruption. In both cases the placement of a percutaneous transgastric prosthesis to drain the pancreatic fluids to the stomach was indicated. The prosthesis remained 183 days on average and there were no mortality cases. This therapeutic minimally invasive alternative has low rates of morbimortality and thus, the endoscopy percutaneous transgastric approach is considered as a viable treatment in PPD. [ABSTRACT FROM AUTHOR]

Presentado en sesión de 19 de agosto de 1936

Las fístulas pancreáticas son debidas a secreción pancreática que drena anormalmente hacia una cavidad interna o al exterior como consecuencia de un proceso patológico trauma o un procedimiento quirúrgico sobre del páncreas que ocasiona lesión de sus conductos. El diagnóstico se basa en la medición de amilasa en el líquido extravasado y su manejo puede ser conservador, lo que implica largas estancias hospitalarias o la práctica de procedimientos quirúrgicos con alta posibilidad de complicaciones. Actualmente se logra el cierre temprano de las fístulas mediante la colocación de prótesis pancreáticas por vía endoscópica.

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Introduction: Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancreatic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction. Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart's modified technique for post-pancreatoduodenectomy reconstruction at Hospital Hernán Henríquez Aravena between 2014 and 2017. Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart's modified technique were included. The modification consisted of the use of Pledgets® (poly-tetrafluoro-ethylene) at the inicial points in páncreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion. Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant. Conclusion: The Blumgart's modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis. [ABSTRACT FROM AUTHOR]

OBJETIVO: Avaliar a morbidade pós-operatória e investigar a existência de seus fatores preditivos. MÉTODOS: O estudo foi realizado de forma retrospectiva, a partir de uma base de dados mantida de forma prospectiva. De 1994 a 2008, 100 pacientes consecutivos foram submetidos à ressecções pancreaticas esquerdas. A principal variável de interesse foi a morbidade pós-operatória, tendo diversas outras características da população sido registradas simultaneamente. Posteriormente, para a análise de fatores preditivos de morbidade pós-operatória o subgrupo de pacientes que foi submetido aos procedimentos de pancreatectomia distal com preservação do baço (n=65) foi analisado separadamente quanto à relevância das diferentes técnicas de secção do parênquima pancreático, assim como, outros possíveis fatores preditivos à ocorrência de morbidade pós-operatória. RESULTADOS: Considerando-se juntamente todas as ressecções pancreáticas esquerdas realizadas, a ocorrência de complicações globais, de complicações relevantes e graves foi 55%, 42% e 20%, respectivamente. Os fatores que se mostraram preditivos à ocorrência de morbidade pós-operatória após pancreatectomia distal com preservação do baço foram a técnica de secção do parênquima pancreático, idade, índice de massa corporal e a realização de operação abdominal concomitante. CONCLUSÃO: A morbidade associada às ressecções pancreáticas, à esquerda dos vasos mesentéricos superiores, foi importante. De acordo com a estratificação adotada baseada na gravidade das complicações, alguns fatores preditivos foram identificados. Estudos futuros com coortes maiores de pacientes são necessários para confirmar tais resultados.OBJECTIVE: To evaluate the postoperative morbidity of distal pancreatic resections and to investigate its predictive factors. METHODS: The study was conducted retrospectively from a prospectively database maintained. From 1994 to 2008, 100 consecutive patients underwent left pancreatic resections. The primary variable of interest was postoperative morbidity, and various other characteristics of the population were simultaneously recorded. Later, for the analysis of predictors of postoperative morbidity, the subgroup of patients who underwent distal pancreatectomy with spleen preservation (n = 65) was separately analyzed with regards to the different techniques of section of the pancreatic parenchyma, as well as to other possible predictors of postoperative morbidity. RESULTS: Considering all left pancreatic resections performed, the occurrence of overall, relevant and serious complications was 55%, 42% and 20%, respectively. The factors predictive of postoperative morbidity after distal pancreatectomy with spleen preservation were the technique employed for section of the pancreatic parenchyma, age, body mass index and the performance of concomitant abdominal operations. CONCLUSION: The morbidity associated with pancreatic resections to the left of the superior mesenteric vessels was high. According to the stratification adopted based on the severity of complications, some predictive factors have been identified. Future studies with larger cohorts of patients are needed to confirm these results.

Introducción: la ruptura del páncreas y el duodeno es un evento poco común, cuyas cifras oscilan entre el 2 y el 4 % de los traumatismos abdominales. La mayoría ocurre en heridas abdominales penetrantes y en traumatismos compresivos en accidentes de tránsito. Métodos: se presenta una serie de 19 pacientes operados por traumatismo pancreaticoduodenal, en 5 hospitales clinicoquirúrgicos de Ciudad de La Habana, desde 2008 a 2010. Se realizó un estudio retrospectivo, mediante el uso de encuestas diseñadas a tal efecto, aplicadas a los cirujanos actuantes en el período estudiado. Resultados: el 63 % de los pacientes fueron por traumatismos cerrados, con predominio de accidentes de tránsito, la mayoría clasificados como grado I (15 pacientes), y 2 pacientes como grado II. Ambos grupos acumularon el 90 % de las lesiones. El procedimiento quirúrgico más frecuentemente empleado fue la pancreatectomía distal con esplenectomía. Se complicaron 8 pacientes (42 %), y la más frecuente fue la fístula pancreática externa en 4 pacientes, seguida por la peritonitis en 2; fallecieron 3 (15 %), distribuidos de la manera siguiente: de 13 pacientes clasificados como grado I, falleció 1 (7 %), y 2 pacientes clasificados como grado III (100 %). Conclusiones: para obtener resultados favorables en este tipo de paciente es necesaria una clasificación acertada según la localización y severidad de las lesiones, así como una adecuada selección del procedimiento quirúrgico.Introduction: rupture of pancreas and duodenum is a uncommon event, whose figures fluctuate between the 2 and the 4 % of the abdominal traumata. Most occur in penetrating abdominal wounds and in compressive traumata in road accidents. Methods: a total of 19 patients were operated on due to a pancreaticoduodenal trauma in five clinical surgical hospitals of Ciudad de La Habana from 2008 to 2010. A retrospective study was conducted using the surveys designed to that end, applied to acting surgeons during the study period. Results: the 63 % of patients had closed traumata with predominance of road accidents, most qualified as grade I (15 patients) and two patients as grade III. Both groups accounted for the 90 % of injuries. The more frequent surgical procedure used was the distal pancreatectomy with splenectomy. Eight patients had complications (42 %) where the most frequent one was the external pancreatic fistula in 4 patients, followed by peritonitis in two patients; three dyed (15 %), distributed as follow: from13 patients classified as degree I, one dyed (7 %) and two patients classified as degree III (100 %). Conclusions: to obtain favorable results in this type of patient, it is necessary an appropriate classification according to location and severity of the injuries, as well as a proper selection of the surgical procedure.

CONTEXT: Diagnosis and treatment of cystic neoplasms of the pancreas increased significantly in the last decades. There are only a few Brazilian publications on these tumors. The majority of them are limited to reports of one or few cases. OBJECTIVE: To present our experience with 27 patients with cystic neoplasms of the pancreas. METHODS: Demographic data, clinical manifestations, diagnostic exams, surgical procedures, postoperative complications, and follow-up data of 27 patients with cystic neoplasms of the pancreas were analyzed, according to the histological type of the tumor. RESULTS: There were 10 (37%) serous cystic tumors, 10 (37%) mucinous cystic tumors, 4 (15%) intraductal papillary mucinous tumors, and 3 (11%) solid pseudopapillary tumors or Frantz tumor. All serous cystic tumors, 6 (60%) mucinous tumors, 2 (50%) intraductal papillary mucinous tumors, and 2 (67%) solid pseudopapillary tumors were benign. The age of the patients varied from 31 to 82 years and all tumors were more common in female. Two patients had been treated previously as a pseudocyst. Surgical procedures depended on the location and extension of the tumor. Two patients underwent only laparotomy with tumor biopsy, one cholecystectomy with Roux-en-Y hepaticojejunostomy for jaundice treatment, 6 pancreatoduodenectomy, and 18 partial pancreatectomy. The most common postoperative complication was pancreatic fistula (n = 5; 19%). One patient died of necrotic pancreatitis. Of the 10 patients with serous cystic tumor, only 1 had tumor recurrence at the section border. The three patients with mucinous cystoadenocarcinoma in which was not possible to resect the tumor, died 6 to 24 months after laparotomy. The six patients with benign mucinous tumors did not have tumor recurrence. CONCLUSIONS: The most common cystic neoplasms of the pancreas are serous and mucinous cysts. These tumors are more frequent in female. Although almost all serous cysts are benign, 40% of mucinous cysts are malign. Misdiagnosis may delay appropriate treatment and increase mortality.RACIONAL: O diagnóstico e tratamento das neoplasias císticas do pâncreas aumentaram significativamente nas últimas décadas. Existem poucas publicações brasileiras sobre estes tumores, sendo que a maioria é limitada à descrição de um ou poucos casos. OBJETIVO: Apresentar a experiência com 27 pacientes com neoplasia cística do pâncreas. MÉTODOS: Os dados demográficos, quadro clínico, exames complementares, procedimento cirúrgico com as suas complicações e a evolução pós-operatória de 27 pacientes com neoplasia cística do pâncreas foram analisados, conforme o tipo histológico do tumor. RESULTADOS: O exame anatomopatológico evidenciou 10 (37%) casos de tumor seroso, 10 (37%) de tumor mucinoso, 4 (15%) de neoplasia intraductal papilar mucinosa e 3 (11%) de neoplasia sólida pseudopapilar ou tumor de Frantz. Todos os tumores serosos, seis (60%) mucinosos, dois (50%) tumores intraductais papilares mucinosos e dois (67%) tumores sólidos pseudopapilares eram benignos. A idade dos pacientes variou amplamente de 31 a 82 anos e o sexo feminino predominou em todos os tipos de tumores. Dois pacientes tinham sido tratados previamente como pseudocisto de pâncreas. As operações realizadas dependiam da localização e extensão do tumor. Dois pacientes foram submetidos somente a laparotomia com biopsia do tumor, 1 a colecistectomia e hepaticojejunostomia em Y-de-Roux para aliviar a icterícia, sem ressecção da neoplasia, 6 a pancreatoduodenectomia e 18 a pancreatectomia parcial. A complicação pós-operatória mais comum foi fístula pancreática (n = 5; 19%). Um paciente morreu no pós-operatório imediato por pancreatite necrótica. Dos 10 pacientes com cistoadenoma seroso, apenas 1 apresentou recidiva próxima à borda de secção do tumor. Os três pacientes com cistoadenocarcinomas mucinosos em que não foi realizada a ressecção do tumor foram a óbito de 6 a 24 meses após a operação. Os seis pacientes com tumores mucinosos benignos não apresentaram recidiva. CONCLUSÕES: As neoplasias císticas pancreáticas mais comuns são os cistos serosos e os mucinosos. Estes tumores ocorrem predominantemente no sexo feminino. Apesar de quase todos os tumores serosos serem benignos, uma percentagem elevada (40%) de tumores mucinosos é maligna. O não reconhecimento desses tumores pode retardar o tratamento adequado e ser associado à elevada mortalidade.

Las fístulas pancreáticas son debidas a secreción pancreática que drena anormalmente hacia una cavidad interna o al exterior como consecuencia de un proceso patológico trauma o un procedimiento quirúrgico sobre del páncreas que ocasiona lesión de sus conductos. El diagnóstico se basa en la medición de amilasa en el líquido extravasado y su manejo puede ser conservador, lo que implica largas estancias hospitalarias o la práctica de procedimientos quirúrgicos con alta posibilidad de complicaciones. Actualmente se logra el cierre temprano de las fístulas mediante la colocación de prótesis pancreáticas por vía endoscópica.Pancreatic fistulae result from pancreatic secretion draining abnormally toward an internal cavity or to the outside as consequence of a pathological process, trauma or a surgical procedure in the pancreas that injuries the ductal pancreatic system. Diagnosis is based on the measurement of the amylase content of the draining fluid, and the management can be conservative, which implies prolonged hospital stays, or surgical procedures that are associated with the probability of complications. Currently it is possible to achieve an early closure of these fistulae by means of the endoscopic introduction of a prosthetic stent.

Pancreatic trauma is a rare but potentially lethal entity which requires a high level of clinical suspicion. Early diagnosis and assessment of the integrity of the pancreatic duct are essential since ductal injury is a crucial predictor of morbimortality. Overall mortality is 19%, which can rise to 30% in cases of ductal injury. The diagnostic and therapeutic approach is multidisciplinary and guided by a surgeon, imaging specialist and ICU physician. Laboratory analysis shows that pancreatic enzymes are frequently elevated, which is a low specificity finding. In hemodynamically stable patients, the posttraumatic condition of the pancreas is firstly evaluated by the multidetector computed tomography. Moreover, in case of suspicion of ductal injury, more sensitive studies such as Endoscopic Retrograde Cholangiopancreatography or cholangioresonance are needed. This narrative review aims to analyze the etiopathogenesis and pathophysiology of pancreatic trauma and discuss its diagnosis and treatment. Also, the most clinically relevant complications will be summarized., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Aims: To compare the short-term outcomes of patients undergoing open DP (ODP) and laparoscopic DP (LDP); and to analyze the association between the section site of the pancreas and pancreatic fistula., Materials and Methods: Clinical, perioperative, and histopathologic data of patients who underwent ODP and LDP between 2009 and 2019 were retrospectively analyzed., Results: 70 patients were included. 39 (56%) underwent ODP and 31 (44%) underwent LDP. The tumor size in ODP group was 70mm and in LDP group was 45mm (p = 0,032) Blood loss was lower in LDP group (229mL versus 498mL) (p = 0,001). Operative time, spleen preservation, B/C pancreatic fistula, major morbidity, reoperation, and length of hospital stay, were similar in both groups. There was no postoperative mortality. No differences were found in B/C pancreatic fistula rate regarding to pancreatic transection site., Conclusions: LDP is a safe procedure, with perioperative outcomes similar to ODP and with less blood loss. The pancreatic transection site did not influence post-operative pancreatic fistula rate., (Copyright: © 2022 Permanyer.)

Se presenta el caso de un paciente de 39 años, bebedor inveterado, intervenido de urgencia por apendicitis aguda, y en dicha operación se encontró pancreatitis aguda necrótico-hemorrágica y peritonitis extensa. Se realizó lavado peritoneal programado y síntesis de la pared por planos; más tarde presentó fiebre y fue necesario drenar un absceso subaponeurótico. Hubo pérdida de peso y apareció supuración por el orificio residual del drenaje dejado. Se pasó un catéter por dicho orificio para irrigación, la secreción aclaró y más tarde salió líquido de posible origen intestinal. La fistulografía demostró una comunicación entre el estómago y el hipocondrio izquierdo, que obligó a una reintervención. El paciente sufrió un hemoperitoneo y se realizó una relaparotomía para esplenectomía en el posoperatorio inmediato. Después estuvo bien, aunque continuó la pérdida de peso. Luego presentó taquicardia sin fiebre y la tomografía axial computarizada mostró una colección intracavitaria en el hipocondrio izquierdo, la cual fue drenada por vía transparietal.This is the case of a heavy drinker patient aged 39, operated on with urgency due to acute appendicitis; during the operation we found a necrotic-hemorrhagic acute pancreatitis and extensive peritonitis. A programmed peritoneal lavage in wall by plans; afterwards he had fever and it was necessary to drain a subaponeurotic abscess. There was a weight loss and a suppuration by residual orifice in drainage made. A catheter was passed through the orifice for irrigation, secretion cleared and then a fluid of possible intestinal origin flowed. The fistulography showed the existence of a communication between the stomach and the left hypochondrium, obliged us to a reintervention. The patient suffered a hemoperitoneum, and thus a second laparoscopy was performed to carry out a splenectomy in the immediate postoperative period. Patient felt well although there was weight loss, tachycardia without fever and computed axial tomography (CAT) showed a intracavitary collection in left hypochondrium, draining by transparietal route.

Postoperative pancreatic fistula in distal pancreatectomy is one of the most important complications in this surgery and it is associated with high morbidity and mortality. Pancreatic fistula after distal pancreatectomy remains an unsolved problem and none preventive procedure has been shown effectively. We present a new technique that combine pancreatic stent placement with round ligament autologous patch over pancreatic edge. A guide is introduced through Wirsung duct prior to stent placement. After stent assessment, Wirsung duct is closed. Finally, falciform ligament autologous patch is placed over pancreatic edge. After 6-8 weeks, the stent is removed by oral endoscopy. This technique introduces a new issue on the pancreatic fistula prevention., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Laparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated., Methods: From November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed., Results: The mean age was 66.5years (IQR 46-74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5minutes (IQR 242-275). The median postoperative hospital stay was 7days (IQR 6-8). After 90days, complications were detected in five patients: three gradeII, one gradeIII and one gradeV according to the modified Clavien-Dindo classification. There was one gradeB pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins., Conclusions: LLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Pylorus-preserving pancreatoduodenectomy with gastric partition (PPPD-GP) seems to be associated to a better postoperative outcome than conventional pancreaticojejunostomy in the setting of a prospective-randomized study. The aim of this study is to further evaluate the surgical outcome in a series of 129 consecutive patients., Methods: Between 2007 and June 2013, 129 patients with periampullary tumors surgically treated with PPPD-GP were retrospectively analyzed. Surgical complications (Clavien-Dindo score), as well as pancreatic and non-pancreas related complications were analyzed., Results: Overall postoperative complication rate was 77%, although 50% of complications were graded I-II by the Clavien-Dindo classification. Incidence of clinically relevant pancreatic fistula was 18%: ISGFP type B: 12%, and type C: 6%. Other pancreas specific complications such as delayed gastric emptying and pospancreatectomy haemorrhage were 27 and 15%, respectively, similar to results published in the literature. Overall perioperative mortality rate was 4.6%., Conclusion: PPPD-GP results show that it is a technique with an acceptable morbidity, low mortality and pancreatic fistula rate similar to other techniques currently described of pancreaticoenteric reconstruction., (Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)