Isolated roux-loop pancreaticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

“…Some authors have named the pancreatic anastomosis the Achilles heel of pancreatic surgery [4]. Hence, numerous surgical techniques and devices have been proposed to prevent fistula formation, such as use of the duct-to-mucosa technique, binding pancreaticojejunostomy, pancreaticogastrostomy reconstruction, Roux-en-Y reconstruction, omental wrapping around the pancreaticojejunostomy, early removal of the drain, but the best technique is still a subject of debate [5,6,7,8,9,10]. …”

Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial

“…[6][7][8][9][10] Many different technical and pharmacologic approaches to deal with soft pancreatic remnants have been attempted, but none have been able to unequivocally and reproducibly lower the pancreatic fistula rate in prospective randomized trials. Failed or unproven strategies include reconstruction with a pancreaticogastrostomy (versus a pancreaticojejunostomy), 11,12 the use of octreotide, 7,13 the use of fibrin glue sealant, [14][15][16] the placement of intra-abdominal drains, 17 the use of an isolated jejunal (Roux-en-Y) limb, 18 and main pancreatic duct occlusion. 19,20 The placement of a plastic stent across the pancreaticojejunostomy (PJ) anastomosis is an attractive strategy to reduce the pancreatic fistula rate following PD.…”

Effect of BioGlue® on the Incidence of Pancreatic Fistula Following Pancreas Resection

“…However, more than 70 technical variations to the pancreaticoenteric anastomosis have not clearly demonstrated an objective method to consistently decrease the rate of fistula which varies from 0% to 40%. 2,7,10,14,16,20,21,[25][26]28,31,42 In our study, we preferred to perform a pancreaticojejunosomy. Other options to consider when performing the pancreatic anastomosis are the duct-to-mucosa versus the invagination techniques.…”

“…[5][6][7][8][9][10] The rate of pancreatic fistula after pancreatic resection varies widely in the literature from 0% to 40% depending on the definition used for pancreatic leak. 2,4,6,10,14,16,17,20,25,28,31,[35][36][37] Pancreatic leak is more common after distal pancreatectomy than pancreaticoduodenectomy. The indication for resection also influences the leak rate with leaks being more common in pathology such as cystic lesions than pancreatitis or pancreatic cancer where the pancreas is firm and the duct is dilated.…”