ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?

Alp Yıldız; Aybala Yıldız

doi:10.24938/kutfd.593709

Research Article

ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?

Year 2020, , 7 - 10, 30.04.2020

Alp Yıldız Aybala Yıldız

https://doi.org/10.24938/kutfd.593709

Abstract

Objective: Splenectomy is a major surgical intervention that brings several complications as well as saving life in the surgical treatment of blunt/penetrating spleen trauma. Although it is a highly standardized procedure in terms of the surgical technique used, pancreatic tail injuries can also be observed, especially during dissection and ligation of the splenic hilum. In this study, we investigated the possible helpful effects of the amylase levels of serum and drainage fluid when there was suspicion for pancreatic injury during splenic hilum dissection.

Material and Methods: Forty-two patients who underwent splenectomy under emergency conditions for splenic injury secondary to acute trauma were included in the study. Nine of the patients developed pancreatic leakage/fistula (Group-1), while 33 did not in the control group (Group-2). Amylase levels measured in both the drain in the site of the surgery and in the serum at postoperative 8, 24, 48 and 72nd hours period were compared. Patients with severe systemic diseases and former hepatobiliary disease excluded.

Results: There was no statistically significant difference in mean blood amylase levels between Group-1 and Group-2 (p>0.05), however, when it was examined with regard to the measured mean amylase levels, the measurement values of Group-1 were significantly higher than those of Group-2 (p<0.05).

Conclusion: Considering tissue ischemia-necrosis, intraabdominal infection-abscesses, possible intraabdominal adhesions, and other serious complications occurred secondary to chemical trauma as a result of the dissemination of pancreatic secretions into the peritoneal cavity, it is very important to protect the peritoneal cavity from contact with these enzymes. For this purpose, we suggest that the use of early stage drainage fluid amylase measurement is very important.

Keywords

splenectomy, pancreatic injury, amylase

References

1. Dragomir M, Petrescu DGE, Manga GE, Călin GA, Vasilescu C. Patients after splenectomy: Old risks and new perspectives. Chirurgia (Bucur). 2016;111(5):393-9.
2. US Department of Health and Human Services, Evidence based management of sickle cell disease, Expert Panel Report 2014. Access date: 23 March 2020: http://scinfo.org/wpcontent/uploads/2014/09/NIH_Report.pdf.
3. Schilling RF. Risks and benefits of splenectomy versus no splenectomy for hereditary spherocytosis-A personal view. Br J Haematol. 2009;145 (6):728-32.
4. Kang JH, Park JS, Yu JS, Chung JJ, Kim JH, Cho ES et al. Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels. PLoS One. 2017;12(5):e0177052.
5. Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg. 2015;22(2):38-45.
6. Teixeira UF, Rodriguez PD, Goldoni MB, Sampaio JA, Fontes PRO. Early drain fluid amylase is useful to predict pancreatic fistula after pancreatoduodenectomy: lessons learned from a Southern Brazilian Center. Arq Gastroenterol. 2018;55(2):160-3.
7. McMillan MT, Soi S, Asbun HJ, Ball CG, Bassi C, Beane JD et al. Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg. 2016;264(1):344-52.
8. Israel JS, Rettammel RJ, Leverson GE, Hanks LR, Cho CS, Winslow ER et al. Does postoperative drain amylase predict pancreatic fistula after pancreatectomy? J Am Coll Surg. 2014;218(1):978-87.
9. Lee CW, Pitt HA, Riall TS, Ronnekleiv-Kelly SS, Israel JS, Leverson GE et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. J Gastrointest Surg. 2014;18(4):1902-10.
10. Dos Santos LV, Lessa MAO, Lima JPSN, Haaland B, Lopes GL. Curative-ıntent surgery for pancreatic tumors: A review of procedures from the Brazilian National Health System. J Glob Oncol. 2016;3(2):37-42.

Drenden Ölçülen Amilaz Değerleri Acil Splenektomi Sonrası İyatrojenik Pankreas Yaralanmasına Sekonder Pankreatik Fistül Gelişimini Öngörmede Faydalı mıdır?

Year 2020, , 7 - 10, 30.04.2020

Alp Yıldız Aybala Yıldız

https://doi.org/10.24938/kutfd.593709

Abstract

Amaç: Künt/delici-kesici dalak travmalarının cerrahi tedavisinde splenektomi, hayat kurtarıcı olduğu ölçüde çeşitli komplikasyonları da beraberinde getiren major bir cerrahi girişimdir. Kullanılan cerrahi teknik açısından son derece standardize edilmiş bir prosedür olmakla beraber özellikle dalak hilusunun diseksiyonu ve bağlanması esnasında pankreas kuyruk yaralanmaları da görülebilmektedir. Bu çalışmada dalak hilus diseksiyonu sırasında iatrojenik pankreas yaralanması şüphesi durumunda serum ve dren amilaz değerlerninin pankreatik kaçak/fistül oluşumunu öngörmedeki başarısı incelendi.

Gereç ve Yöntemler: Akut travmaya sekonder Grade 3-4 dalak yaralanması nedeniyle acil koşullarda splenektomi yapılan 42 hasta çalışmaya dahil edildi. Pankreatik kaçak izlenenen hastalar ile (Grup-1: 9 olgu), kaçak izlenmeyen hastaların (Grup-2: 33 olgu) postoperatif dönemde 8, 24, 48 ve 72. saatlerde hem operasyon lojundaki drenden hem kandan alınan amilaz-lipaz ölçüm değerleri açısından karşılaştırıldı. Ağır sistemik hastalığı bulunanlarla, bilinen hepatobiliyer sistem ve pankreas patolojisi bulunan hastalar çalışma dışı bırakıldı.

Bulgular: Grup-1 ve Grup-2 arasında ortalama serum amilaz düzeyleri açısından istatistiksel olarak anlamlı fark izlenmezken (p>0.05), drenden ölçülen ortalama amilaz değerleri açısından incelendiğinde Grup-1’in ölçüm değerleri Grup-2’ye göre istatistiksel olarak anlamlı derecede yüksekti (p<0.05).

Sonuç: Pankreas salgılarının peritoneal boşluğa olan disseminasyonları sonucu oluşacak kimyasal travmaya sekonder gelişebilecek doku iskemi-nekrozu, intraabdominal enfeksiyon-abseler, olası intraabdominal adezyonlar ve diğer ciddi komplikasyonlar düşünüldüğünde, peritoneal boşluğun bu enzimlerle temasından korunmasının oldukça önemli olduğunu düşünmekteyiz. Bu amaca yönelik olarak pankreatik yaralanma şüphesi olan olgularda drenden ölçülecek amilaz değerlerinin oldukça önemli olabileceği görüşündeyiz.

Keywords

splenektomi, pankreas yaralanması, amilaz

References

1. Dragomir M, Petrescu DGE, Manga GE, Călin GA, Vasilescu C. Patients after splenectomy: Old risks and new perspectives. Chirurgia (Bucur). 2016;111(5):393-9.
2. US Department of Health and Human Services, Evidence based management of sickle cell disease, Expert Panel Report 2014. Access date: 23 March 2020: http://scinfo.org/wpcontent/uploads/2014/09/NIH_Report.pdf.
3. Schilling RF. Risks and benefits of splenectomy versus no splenectomy for hereditary spherocytosis-A personal view. Br J Haematol. 2009;145 (6):728-32.
4. Kang JH, Park JS, Yu JS, Chung JJ, Kim JH, Cho ES et al. Prediction of pancreatic fistula after pancreatoduodenectomy by preoperative dynamic CT and fecal elastase-1 levels. PLoS One. 2017;12(5):e0177052.
5. Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg. 2015;22(2):38-45.
6. Teixeira UF, Rodriguez PD, Goldoni MB, Sampaio JA, Fontes PRO. Early drain fluid amylase is useful to predict pancreatic fistula after pancreatoduodenectomy: lessons learned from a Southern Brazilian Center. Arq Gastroenterol. 2018;55(2):160-3.
7. McMillan MT, Soi S, Asbun HJ, Ball CG, Bassi C, Beane JD et al. Risk-adjusted outcomes of clinically relevant pancreatic fistula following pancreatoduodenectomy: a model for performance evaluation. Ann Surg. 2016;264(1):344-52.
8. Israel JS, Rettammel RJ, Leverson GE, Hanks LR, Cho CS, Winslow ER et al. Does postoperative drain amylase predict pancreatic fistula after pancreatectomy? J Am Coll Surg. 2014;218(1):978-87.
9. Lee CW, Pitt HA, Riall TS, Ronnekleiv-Kelly SS, Israel JS, Leverson GE et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. J Gastrointest Surg. 2014;18(4):1902-10.
10. Dos Santos LV, Lessa MAO, Lima JPSN, Haaland B, Lopes GL. Curative-ıntent surgery for pancreatic tumors: A review of procedures from the Brazilian National Health System. J Glob Oncol. 2016;3(2):37-42.

There are 10 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Articles
Authors	Alp Yıldız This is me 0000-0002-6800-138X Aybala Yıldız This is me 0000-0002-7894-6846
Publication Date	April 30, 2020
Submission Date	July 18, 2019
Published in Issue	Year 2020

Cite

APA	Yıldız, A., & Yıldız, A. (2020). ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?. The Journal of Kırıkkale University Faculty of Medicine, 22(1), 7-10. https://doi.org/10.24938/kutfd.593709
AMA	Yıldız A, Yıldız A. ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?. Kırıkkale Üni Tıp Derg. April 2020;22(1):7-10. doi:10.24938/kutfd.593709
Chicago	Yıldız, Alp, and Aybala Yıldız. “ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?”. The Journal of Kırıkkale University Faculty of Medicine 22, no. 1 (April 2020): 7-10. https://doi.org/10.24938/kutfd.593709.
EndNote	Yıldız A, Yıldız A (April 1, 2020) ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?. The Journal of Kırıkkale University Faculty of Medicine 22 1 7–10.
IEEE	A. Yıldız and A. Yıldız, “ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?”, Kırıkkale Üni Tıp Derg, vol. 22, no. 1, pp. 7–10, 2020, doi: 10.24938/kutfd.593709.
ISNAD	Yıldız, Alp - Yıldız, Aybala. “ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?”. The Journal of Kırıkkale University Faculty of Medicine 22/1 (April 2020), 7-10. https://doi.org/10.24938/kutfd.593709.
JAMA	Yıldız A, Yıldız A. ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?. Kırıkkale Üni Tıp Derg. 2020;22:7–10.
MLA	Yıldız, Alp and Aybala Yıldız. “ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?”. The Journal of Kırıkkale University Faculty of Medicine, vol. 22, no. 1, 2020, pp. 7-10, doi:10.24938/kutfd.593709.
Vancouver	Yıldız A, Yıldız A. ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?. Kırıkkale Üni Tıp Derg. 2020;22(1):7-10.