Pancreaticogastrostomy After Pancreatoduodenectomy

Pikarsky, Alon J.; Muggia-Sullam, Michael; Eid, Ahmed; Lyass, Sergey; Bloom, Allan I.; Durst, A; Shiloni, Eitan

doi:10.1001/archsurg.1997.01430270082016

Cited by 33 publications

(27 citation statements)

References 14 publications

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“…There are a number of plausible explanations for why PG may be superior to PJ reconstruction in reducing the POPF rate. First, deleterious tissue digestion around the PG site may be prevented because pancreatic enzymes are not activated by the gastric acidic environment and a lack of enterokinase in the gastric lumen. Second, the rich blood supply to the stomach wall promotes PG healing and the larger area of stomach wall makes invagination of the pancreatic stump into the stomach technically easier, especially when the pancreatic stump is bulky.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy

Xiong

Tan

Szatmary

et al. 2014

British Journal of Surgery

118

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy

Xiong

Tan

Szatmary

et al. 2014

British Journal of Surgery

118

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“…The higher rate of a grade A PF in the PG group suggest that although the risk of a biochemical fistula is higher in PG the clinical consequences are less severe compared with the pancreatic leak after PJ reconstruction. This could be because of several reasons: inhibition of pancreatic enzyme activation by acid environment, an absence of enterokinase in the stomach (necessary for activation of trypsinogen), 27 a thick‐walled stomach with an excellent blood supply, 17 prevention of marginal ulceration by neutralization of acid by pancreatic juices, decompression of the stomach by the nasal gastric tube preventing stasis of gastric and pancreatic contents, and the absence of the long jejunal loop with the accumulation of biliary and pancreatic contents 17 …”

Section: Discussionmentioning

confidence: 99%

Outcomes comparing a pancreaticogastrostomy (PG) and a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD)

Aroori

Puneet

Bramhall

et al. 2011

HPB

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“…Pancreatogastrostomy has been reported to be better than pancreatojejunostomy from the viewpoint of anastomotic leakage 33,34. On the other hand, Yeo et al7 reported no difference in the frequency of pancreatic anastomotic leakage between the two anastomoses by a prospective randomized study.…”

Section: Discussionmentioning

confidence: 99%

Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998

Yamaguchi

Tanaka

Chijiiwa

et al. 1999

Journal of Hepato-Biliary-Pancreatic Surgery

137

119

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Early (within 1 month after operation) and late (more than 1 month after surgery) complications after pylorus-preserving pancreatoduodenectomy (PpPD) were analyzed in 1066 Japanese patients collected from 74 authentic institutions in Japan. As early postoperative complications after PpPD, delayed gastric emptying was evident in 46% of patients, pancreatoenterostomy leakage in 16%, intra-abdominal infection in 14%, cholangitis in 8.9%, hepaticojejunostomy leakage in 4.7%, intra-abdominal hemorrhage in 3. 5%, upper gastrointestinal hemorrhage in 3.2%, and duodenojejunostomy leakage in 2.0%. Delayed gastric emptying resolved 1-24 months after PpPD (mean, 3.1 months). The direct operative mortality (death within 1 month after the operation) was 2. 4%. Univariate and multivariate analysis of pancreatoenterostomy leakage showed that male sex (P = 0.0151) and soft consistency of the pancreas (P < 0.0001) were independent significant factors. Univariate analysis of delayed gastric emptying showed that establishment of gastrostomy (P < 0.0001), length of the preserved duodenum (P = 0.0406), gastric juice output (P = 0.0001), length of gastric tube placement (P < 0.0001), and administration of cisapride (P = 0.0059) were significant variants. As late complications, stomal ulcer was evident in 3.6% of patients, cholangitis in 6.7%, and liver abscess in 1.2%. Glucose intolerance appeared in 61 patients, resolved in 15, showed no change in 170, was absent in 695, and was ameliorated in 17. As a result, the dosage of hypoglycemic agents or insulin showed no change in 187 patients, decreased in 16, and increased in 52. Diabetes appeared 0-42 months after PpPD (mean, 102 months). When present, diabetes deteriorated 0-36 months postoperatively (mean, 6.3 months). Univariate analysis of the appearance or deterioration of diabetes showed that diabetes occurred more frequently in the following patients; those with Billroth I reconstruction compared with those with Billroth II (P = 0.0041), those with pancreatogastrostomy vs those with pancreatojejunostomy (P = 0.0229), those with pancreatogastrostomy vs those with end-to-side pancreatojejunostomy (P = 0.0165), and those with total tube drainage vs those with pancreatico-whole thickness anastomosis (P = 0.0392); a high American Society of Anesthesiologist (ASA) score (P = 0.0211) and pancreatoenterostomy leakage (P = 0.0361) were also significant factors. Postoperative body weight loss (>3 kg) was evident in 62% of patients. Body weight loss reached a maximum 4.2 +/- 5.8 months after PpPD (mean, 6.0 kg) and returned to the preoperative level 4.8 months thereafter. These results suggest that PpPD has been performed safely in Japan, the operative mortality being 2.4%. However, delayed gastric emptying was evident in 46% of the patients and pancreatoenterostomy leakage in 16%. Impairment of glucose tolerance occurred in about 10% of patients more than 1 month after PpPD. Therefore, during the early postoperative period, patients should be closely monitored for pancreatoenterostomy leaka...

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Pancreaticogastrostomy After Pancreatoduodenectomy

Abstract: Pancreaticogastrostomy is a safe method for reconstruction of the pancreatic remnant after pancreatoduodenectomy for periampullary tumors. It results in an acceptable incidence of anastomotic leakage that is easily controlled by conservative measures.

Cited by 33 publications

References 14 publications

Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy

Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy

Outcomes comparing a pancreaticogastrostomy (PG) and a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD)

Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998

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