Intra-arterial bolus octreotide administration during Whipple procedure
in patients with fragile pancreas: A novel technique for safer
pancreaticojejunostomy
Background and Objectives: Leakage from the pancreaticojujenostomy is
the most serious complication of Whipple. Pancreatic fistula rate is
higher in cases of fragile pancreas often seen in duodenal carcinomas
and carcinomas of the ampulla of Vater. Octreotide administration has
been used for the prevention of fistula formation through the
subcutaneous route. Due to its physiologic effects to the pancreatic
parenchyma the intra-arterial administration of octreotide could provide
tissue hardening that allows for a technically easier anastomosis while
maintaining its protective role for fistula formation.
Methods: Octreotide was injected directly into the distal part of the
gastroduodenal artery (GDA) in four patients undergoing Whipple for
histologically proven periampullary cancer.
Results: Tissue hardening after octreotide administration was evident
not only in surgeons’ hands but in the intra-operative ultrasound as
well. The three patients were discharged on day 9, 11, and 13; they had
an uneventful postoperative course, while one patient had a minor bile
leak from the choledojejunal anastomosis and was discharged on day 22.
Conclusions: The intra-arterial administration of octreotide during
Whipple is a safe procedure and provides tissue hardening thus making
the performance of the anastomosis technically easier. The actual
benefit in terms of morbidity, mortality, and fistula rate are to be
further evaluated. (C) 2005 Wiley-Liss, Inc