No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

Akihiro Cho; Satoshi Katagiri; Masao Ota; Shunsuke Onizawa; Ryota Higuchi; Toshiya Sugishita; Yukiko Niwa; Takeshi Ishita; Toshihiko Mouri; Akita Kato; Moe Iwata

doi:10.4240/wjgs.v16.i6.1910

No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

World J Gastrointest Surg. 2024 Jun 27;16(6):1910-1917. doi: 10.4240/wjgs.v16.i6.1910.

Authors

Affiliations

¹ Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan. acho5184@gmail.com.
² Division of Gastroenterological Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba 276-8524, Japan.

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 14^th and 10^th 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.

Keywords: Case report; Emergency pancreaticoduodenectomy; Neoplastic bleeding; No-touch isolation technique; Pancreaticoduodenectomy; Superior mesenteric artery first approach.

Publication types

Case Reports