Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy

Payne, R F; Pain, J. A.

doi:10.1002/bjs.5191

Cited by 45 publications

(42 citation statements)

References 23 publications

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“…Although the mortality rate of this reconstructive procedure following PD has decreased to 5% or less in recent years, the incidence of pancreatic fistulae, which is a leading cause of operative death, has been reported to remain in the range of 10-18% for the past 10 years [5][6][7][8][9][10]. On the other hand, an alternative pancreaticoenteric procedure, PG has been recently reported to have lower rates of pancreatic fistula (0-13%) and operative mortality (0-4.8%) [15][16][17][18][19][20][21][22][23][24][25]. To our knowledge, there have been three randomized controlled trials of PJ versus PG following PD reported in the previous English literature.…”

Section: Discussionmentioning

confidence: 99%

No mortality after 150 consecutive pancreatoduodenctomies with duct‐to‐mucosa pancreaticogastrostomy

Murakami

Uemura

Hayashidani

et al. 2007

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

No mortality after 150 consecutive pancreatoduodenctomies with duct‐to‐mucosa pancreaticogastrostomy

Murakami

Uemura

Hayashidani

et al. 2007

Journal of Surgical Oncology

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“…However, comparative analyses of pancreaticoenterostomy in many studies have been performed with various surgical methods. In addition, some authors reported the superiority of PG with no control group included [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Which Method Should We Select for Pancreatic Anastomosis After Pancreaticoduodenectomy?

et al. 2008

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Background This study was designed to compare surgical, morphological, and functional outcomes of pancreaticoduodenectomy (PD) according to the types of pancreaticoenterostomy performed and to suggest a proper anastomotic method after PD. Methods From January 2001 to December 2006, 147 PDs were performed at Ajou University Medical Center. Surgical, morphological, functional, and nutritional outcomes after PD were retrospectively compared according to the types of management of pancreatic remnant and whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ), including duct-to-mucosa or invagination method, was performed. Results For the reconstruction method, 43 PG (30 ductto-mucosa and 13 invagination) and 100 PJ (33 duct-tomucosa and 67 invagination) were performed. Pancreatic leak rate in PG group (7%) was less than that in PJ group (13%); however, it was not significant (P [ 0.05). On the other hand, there was a significant difference in pancreatic leak between duct-to-mucosa and invagination (3.2 vs. 17.5%, P \ 0.05). Surprisingly, there was no pancreatic leak in PG duct-to-mucosa anastomosis after PD. There were no significant differences in the change of remnant pancreatic duct size, pancreatic thickness, presence of steatorrhea, and new-onset diabetes mellitus (DM) between PG and PJ. In the invagination group, the main pancreatic duct diameter was increased and pancreatic thickness was progressively reduced. Conclusion The duct-to-mucosa method is safer and has a good duct patency and low pancreas atrophy compared with the invagination method. In addition, PG duct-tomucosa is safer than PG invagination, but not in the PJ group. Therefore, we recommend PG duct-to-mucosa for reconstruction after PD because of safety and good duct patency, especially for inexperienced surgeons.

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“…Among them, a small pancreatic duct size with a soft pancreas creates one of the technical hurdles to the completion of the anastomosis, and is known to be a risk factor for major leakage [3,[8][9][10][11][12][13] . Several methods have been advocated to reduce the occurrence of leakage [5,[14][15][16][17][18][19][20][21] , but the best technique is still a subject of debate [22][23][24][25][26][27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

Hakamada¹,

Narumi²,

Toyoki³

et al. 2008

WJG

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AIM:To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fastabsorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture. METHODS:Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fastabsorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis. RESULTS:The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen. CONCLUSION:A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas. Hakamada K, Narumi S, Toyoki Y, Nara M, Ishido K, Miura T, Kubo N, Sasaki M. An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture.

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Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy

Abstract: Two-layered duct-to-mucosa pancreaticogastrostomy for restoration of pancreaticoenteric continuity after pancreaticoduodenectomy is associated with a low incidence of complications.

Cited by 45 publications

References 23 publications

No mortality after 150 consecutive pancreatoduodenctomies with duct‐to‐mucosa pancreaticogastrostomy

No mortality after 150 consecutive pancreatoduodenctomies with duct‐to‐mucosa pancreaticogastrostomy

Which Method Should We Select for Pancreatic Anastomosis After Pancreaticoduodenectomy?

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

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