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How to prevent the postoperative pancreatic fistula with
an ethylene vinyl alcohol copolymer (Onyx): 
A proposal of a new technique

Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):248-52
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Francesco Crafa1, Francesco Esposito1, Adele Noviello1, Nicola Moles1, Enrico Coppola Bottazzi1, Carmelo Lombardi2, Antonio Miro1, Giulio Lombardi2

1Oncological and General Surgery Unit and 2Department of Radiology, 
“St. Giuseppe Moscati” Hospital of National Relevance and High Specialty, Avellino, Italy
Received December 10, 2017; Revised June 10, 2018; Accepted June 14, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Despite the advances in identifying risk factors, improving operative technique, and postoperative patient care, pancreatic leakage after pancreatic resection remains a highly debated topic. The aim of this study is to describe our technique and our initial experience with the intraoperative embolization of the main pancreatic duct with an Ethylene Vinyl Alcohol Copolymer (Onyx). 
Methods: Two patients of 63 and 64 years underwent pancreaticoduodenectomy for a cholangiocarcinoma of the extrahepatic bile duct and a pancreatic adenocarcinoma, respectively. At the time of pancreatic parenchyma resection, a Wirsung duct was identified and catheterized. A wirsungography was done and then, embolization with Onyx was carried out under fluoroscopic control. 
Results: Neither of the patients developed a postoperative pancreatic fistula. They were discharged to home on the 17th and 18th post-operative day, respectively. At the last follow-up, no recurrence was found. The two patients became diabetics; both needed the support of supplementary pancreatic enzymes. 
Conclusions: To our knowledge, we are the first to describe this technique, which seems safe and reliable. Studies on this subject with more patients are needed to confirm the validity of this procedure.
Keywords : Postoperative pancreatic fistula; Pancreaticoduodenectomy; Onyx


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