After completion of the vascular anastomosis, drainage of a transplanted pancreas is accomplished by anastomosis to: (AIIMS Nov 2011)
|D||Bladder or swall bowel|
(Ref: Schwartz :Principles of surgery 8th edition page no.429)
a. In addition to the expected problems associated with immunologic rejections, major problem in pancreas transplant is difficulty in establishing the drainage of the pancreatic duct.
b. Ligation of the pancreatic duct practically leads to the severe inflammatory reaction.
c. It leads to the constricting fibrosis that damages the islets even.
d. With most pancreas transplants the transplant pancreatic exocrine secretions are managed with urinary bladder drainage.
e. Because of the associated metabolic and infectious complications, many pancreatic transplants require later conversion to enteric drainage, and the trend in this country is now toward primary enteric drainage.
f. But fistulas are common.
g. Both enteric drainage and bladder drainage now have a relatively low surgical risk.
h. Unlike with urinary bladder drainage when direct cystoscopy can be performed, a disadvantage with enteric drainage is that problems such as bleeding from a transplanted pancreas and attached duodenal segment are not easily evaluated.
i. The main advantage of bladder drainage is the ability to directly measure enzyme activity in the pancreatic graft exocrine secretions by measuring the amount of amylase in the urine.
j. A decrease in urine amylase is a sensitive marker for rejection, even through it is not entirely specific.
k. Urine amylase always decreases before hyperglycemia ensues.
l. If the kidney and pancreas are from different donors, or if a pancreas transplant alone (PTH) is performed, then bladder drainage is preferred, so rejection of the pancreas can be detected earlier.
m. The use of short segment of duodenum anastomosed to bladder seems to be the most successful solution.