Pancreaticogastrostomy Is Superior to Pancreaticojejunostomy for Prevention of Pancreatic Fistula After Pancreaticoduodenectomy

Menahem, Benjamin; Guittet, Lydia; Mulliri, Andréa; Alvès, Arnaud; Lubrano, Jean

doi:10.1097/sla.0000000000000806

Cited by 128 publications

(77 citation statements)

References 28 publications

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“…It has been claimed that PG is a better pancreatic reconstruction method because it reduces the incidence and severity of POPF. Four recent meta-analyses based on eight randomized control trials have concluded that the POPF rate is significantly lower in PG than in PJ [28][29][30]. We recommended sutureless PG as an alternative to PJ because of the following advantages: (i) there is an absence of trans-pancreatic sutures because the trans-parenchymal sutures cause damage to the pancreatic tissues and leakage; (ii) PG is performed for a short time because of the proximity of the stomach to the pancreas; (iii) the stomach wall is well-vascularized and thick; (iv) there is early detection of intraluminal bleeding from the pancreatic remnant; (v) the pancreatic enzymes are inactive due to the high acidity in the stomach and a lack of enterokinase, which prevents a digestive damage to the PG; (vi) PG is isolated and is spaced apart from a. mesenterica superior, a. hepatica propria, v. portae and v. mesenterica superior; (vii) gastric decompression by a nasogastric tube eliminates gastric and pancreatic secretions, exerts less tension on PG, and can be used as a drainage if fistula occurs; and (viii) PG decreases the number of anastomoses in a single loop of jejunum, reducing the probability of loop kinking.…”

Section: Discussionmentioning

confidence: 99%

Turkish Validation and Adaptation of Children ’s Chronotype Questionnaire (CCTQ)

Dursun

Öğütlü

Esın

2015

EAJM

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Objective: The present study aimed to assess the safety of pancreatic anastomosis after pancreaticoduodenectomy (PD) and to compare the results of sutureless pancreatogastrostomy (PG) with those of single-layer duct-to-mucosa pancreatojejunostomy (PJ) after PD in patients with malignant disease of the pancreatic head and of the periampullary region. Materials and Methods:The study included 173 consecutive patients undergoing PD from May 2009 to December 2015 at a single surgical center. Single-layer duct-to-mucosa PJ was performed in 52 patients and sutureless PG in the remaining 123. The primary endpoint was the safety of the procedures, which was assessed as the occurrence of complications during hospitalization. Postoperative pancreatic fistula (POPF) was classified as grade A, B, or C according to the International Study Group of Pancreatic Fistula classification.Results: We found that the incidence of POPF was 11.52%. With regard to POPF, the present study showed no significant difference in the two groups (p=0.043). The incidence of Grade C POPF was significantly higher in the PJ group than in the PG group (p=0.001), which was been reflected in the form of a higher rate of postoperative hemorrhage (p=0.001), intra-abdominal abscess (p=0.012), and septic shock (p=0.012) events in the PJ group. Conclusion:The evaluation of short-term outcomes demonstrates that suturelessPG is a feasible and safe technique, associated with lower life-threatening complications than single-layer duct-to-mucosa PJ. If longterm functional outcomes confirm similar results, sutureless PG could become a valid alternative for pancreatic anastomosis after PD in patients with soft pancreas and high morbidity. Bulgular: Çalışmamızda POPF oranı %11,52 olarak bulundu. İki grup arasında anlamlı bir farklılık görülmedi (p=0,043). Evre C POPF insidansı PJ' de PG grubuna göre anlamlı ölçüde daha yüksekti (p=0,001), Ayrıca PJ grubunda postoperatif hemoraji (p=0,001), intraabdominal apse (p=0,012) ve septik şok (p=0,012) vakalarının oranları da daha yüksek bulundu.Sonuç: Kısa dönem sonuçların değerlendirilmesine göre, tek katlı duct-to-mukozal PJ ile kıyaslandığında dikiş-siz PG daha düşük oranda yaşamı tehdit eden komplikasyonlarından dolayı uygulanabilir ve güvenli bir tekniktir. Uzun dönem fonksiyonel sonuçlarla benzer bulgular doğrulandığı takdirde dikişsiz PG, yumuşak yapılı pankreası ve yüksek morbiditesi olan hastalarda PD sonrası pankreatik anastomoz için geçerli bir alternatif olabilir.

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Section: Discussionmentioning

confidence: 99%

Turkish Validation and Adaptation of Children ’s Chronotype Questionnaire (CCTQ)

Dursun

Öğütlü

Esın

2015

EAJM

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“…Regarding operative factors, the type of pancreatic anastomosis is chosen according to a surgeon's experience 3 . For reconstruction of the pancreas remnant after PD, two main methods of anastomosis have been described: pancreatogastrostomy and pancreatojejunostomy 22,29 . In a previous meta-analysis of seven randomized controlled trails, Liu et al 23 demonstrated that pancreatogastrostomy is more efficient than pancreatojejunostomy in reducing the incidence of clinically relevant pancreatic fistula.…”

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 99%

Pancreatoduodenectomy: Brazilian practice patterns

Waechter¹,

Amaral²,

Costa³

et al. 2018

HPB

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-Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim: To understand the Brazilian practice patterns for pancreatoduodenectomy. Method: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy.

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“…Still, pancreatic surgery remains highly complex and is associated with significant morbidity and mortality rates (11)(12)(13). Therefore, when starting a robotic program for pancreatic surgery, it should be well prepared and several conditions must be met prior to performing the first procedures.…”

Section: Introductionmentioning

confidence: 99%

Developing a robotic pancreas program: the Dutch experience

et al. 2017

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Robot-assisted surgery has been developed to overcome limitations of conventional laparoscopy aiming to further optimize minimally invasive surgery. Despite the fact that robotics already have been widely adopted in urology, gynecology, and several gastro-intestinal procedures, like colorectal surgery, pancreatic surgery lags behind. Due to the complex nature of the procedure, surgeons probably have been hesitant to apply minimally invasive techniques in pancreatic surgery. Nevertheless, the past few years pancreatic surgery has been catching up. An increasing number of procedures are being performed laparoscopically and robotically, despite it being a highly complex procedure with high morbidity and mortality rates. Since the complex nature and extensiveness of the procedure, the start of a robotic pancreatic program should be properly prepared and should comply with several conditions within high-volume centers. Robotic training plays a significant role in the preparation. In this review we discuss the different aspects of preparation when working towards the start of a robotic pancreas program against the background of our nationwide experience in the Netherlands. a 3D, magnified view of the operative field with intraabdominal articulating instruments, thereby increasing surgical dexterity (8). Potentially, the use of the robotic system enables a larger proportion of pancreatic surgeries to be performed minimally invasively, since the technical benefits of the robot may especially be advantageous in reconstructing anastomoses during a Whipple procedure. Moreover, ergonomics are improved and the use of robotics in minimally invasive surgery potentially shortens the learning curve compared to conventional laparoscopy, as previously shown in different procedures (9,10).Still, pancreatic surgery remains highly complex and is associated with significant morbidity and mortality rates (11-13). Therefore, when starting a robotic program for pancreatic surgery, it should be well prepared and several conditions must be met prior to performing the first procedures. Training of a dedicated multidisciplinary team should play a key-role in the setup. However, specific training programs for teams performing robotic pancreatic surgery are still scarce.In the Netherlands, surgeons have been performing laparoscopic pancreatic surgery sporadically for over ten years (1). In 2012, the first robot-assisted distal pancreatectomies were performed and last year the first robot-assisted pancreatoduodenectomies were performed in the University Medical Center Utrecht (UMC Utrecht) after following the University of Pittsburgh Medical Center (UPMC) training program. Next, this program made available nationwide by the Dutch Pancreatic Cancer Group, similar as was done previously for laparoscopic pancreatic surgery (1). Other centers, including the Erasmus Medical Center Rotterdam, recently followed the program. In this review we discuss the steps we took on our road to our first successful robot-assisted pancreatoduodenectomy. T...

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Pancreaticogastrostomy Is Superior to Pancreaticojejunostomy for Prevention of Pancreatic Fistula After Pancreaticoduodenectomy

Abstract: In PD, reconstruction by PG is associated with lower postoperative pancreatic and biliary fistula rates.

Cited by 128 publications

References 28 publications

Turkish Validation and Adaptation of Children ’s Chronotype Questionnaire (CCTQ)

Turkish Validation and Adaptation of Children ’s Chronotype Questionnaire (CCTQ)

Pancreatoduodenectomy: Brazilian practice patterns

Developing a robotic pancreas program: the Dutch experience

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