Cho A, Katagiri S, Ota M, Onizawa S, Higuchi R, Sugishita T, Niwa Y, Ishita T, Mouri T, Kato A, Iwata M. No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature. World J Gastrointest Surg 2024; 16(6): 1910-1917 [PMID: 38983346 DOI: 10.4240/wjgs.v16.i6.1910]
Corresponding Author of This Article
Akihiro Cho, MD, PhD, Associate Professor, Doctor, Surgeon, Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba 276-8524, Japan. acho5184@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Akihiro Cho, Satoshi Katagiri, Masao Ota, Shunsuke Onizawa, Ryota Higuchi, Toshiya Sugishita, Yukiko Niwa, Takeshi Ishita, Toshihiko Mouri, Akita Kato, Moe Iwata, Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan
Author contributions: Cho A selected the associated data and edited the article; Cho A, Onizawa S, Sugishita T, Niwa Y, and Kato A participated in the surgery; Higuchi R, Ishita T, Mouri T, and Iwata M contributed to patient treatment; Katagiri S and Ota M revised the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akihiro Cho, MD, PhD, Associate Professor, Doctor, Surgeon, Division of Gastroenterological Surgery, Tokyo Women’s Medical University, Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo, Chiba 276-8524, Japan. acho5184@gmail.com
Received: January 26, 2024 Revised: April 8, 2024 Accepted: April 30, 2024 Published online: June 27, 2024 Processing time: 156 Days and 3.8 Hours
Abstract
BACKGROUND
Emergency pancreaticoduodenectomy (EPD) is a rare event for complex periampullary etiology. Increased intraoperative blood loss is correlated with poor postoperative outcomes.
CASE SUMMARY
Two patients underwent EPD using a no-touch isolation technique, in which all arteries supplying the pancreatic head region were ligated and divided before manipulation of the pancreatic head and duodenum. The operative times were 220 and 239 min, and the blood loss was 70 and 270 g, respectively. The patients were discharged on the 14th and 10th postoperative day, respectively. Thirty-two patients underwent EPD for the treatment of neoplastic bleeding. The mean operative time was 361.6 min, and the mean blood loss was 747.3 g. The complication rate was 37.5%. The in-hospital mortality rate was 9.38%.
CONCLUSION
The no-touch isolation technique is feasible, safe, and effective for reducing intraoperative blood loss in EPD.
Core Tip: Emergency pancreaticoduodenectomy (EPD) has been rarely reported as a life-saving procedure. Morbidity and mortality rates remain very high for EPD. Increased intraoperative blood loss has been linked to worse postoperative results. The non-touch isolation technique is feasible, safe, and effective in minimizing intraoperative blood loss in EPD.
