Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis

Wente, Moritz N.; Shrikhande, Shailesh V.; Müller, Michael; Diener, Markus K.; Seiler, Christoph M.; Frieß, Helmut; Büchler, Markus W.

doi:10.1016/j.amjsurg.2006.10.010

Cited by 232 publications

(178 citation statements)

References 47 publications

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“…There has been a debate regarding PG versus PJ, but the current evidence does not suggest superiority of one technique over the other [57][58][59][60]. It is possible to achieve fistula rates of less than 5-10 % irrespective of the technique used.…”

Section: Pancreaticogastrostomy (Pg) Versus Pancreaticojejunostomy (Pj)mentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

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Section: Pancreaticogastrostomy (Pg) Versus Pancreaticojejunostomy (Pj)mentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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“…The findings of PG have been compared to PJ in more than a dozen retrospective studies which almost invariably have demonstrated the superiority of PG. A recent meta-analysis has reported that average pancreatic fistula rate was significantly lower (3.7%) after PG than PJ (16.5%) with a significant difference in mortality of 3% after PG compared with 9% after PJ and lower intra-abdominal complications than PJ [16][17].…”

Section: Discussionmentioning

confidence: 99%

A novel pancreatogastrostomy method using only one purse string suture and four corner mucosal sutures: early post operative surgical results

Godara¹,

Tamaknand²,

Verma³

2018

Int J Surg Med

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Objective: Pancreatic fistula remains the single most important cause of morbidity following Pancreatoduodenectomy (PD) and perhaps contributes most to increased mortality. Pancreatogastrostomy (PG) has been used by many surgeons in recent years because of its theoretical advantages over Pancreatojejunostomy (PJ). In this study, we analysed the outcome of modified binding PG technique following PD. Methods and Material: 20 consecutive patients were studied from April 2013 to March 2015 all of whom underwent binding PG after PD, where a single purse-string suture was taken on the posterior wall of the stomach with additional four mucosal corner sutures thereby creating a Pancreato-gastric anastomosis. Results: We prospectively analysed patient characteristics, perioperative outcomes and surgical results. In this average study age was 50.9 years with body mass index 21.5±2.6 kg/ m 2 . All patients underwent standard PD and meant operative time was 377.5±44.14 minutes.The mean operative time taken to complete pancreatogastrostomy after complete mobilisation of the pancreatic stump was 9.2 minutes(range 7-11minutes). Mean hospital stay was 16.55±3.83 days (range, 8 to 21 days). Postoperative mortality was 5% (n=1) due to pneumonitis. Only two patients developed Grade A pancreatic fistula, which were managed conservatively. One patient had postoperative haemorrhage, and four patients developed delayed gastric emptying (DGE). Conclusion: Results of our study are auspicious, proving that modified binding PG is a simple, fast and safe reconstruction procedure after PD. However, to determine its superiority over conventional PG, this procedure needs to be more comprehensively evaluated in a larger group of patients.

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“…The digestive tract partner, stitching technique and material used are also discussed [1, 9,12]. However, there is no consensus on any of the mentioned points.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Anastomosis Healing

Hać¹,

Pęksa²,

Dobosz³

et al. 2012

OJPathology

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Background: Pancreatoduodenectomy (PD) is a complex procedure with a relatively high risk of complications. There is an increasing trend showing that the success of pancreato-enteral anastomosis depends on surgical skill and the material used. Methods: We present four cases of pancreato-enteral anastomosis resected 37 -114 days after primary surgery and the analysis of the healing process, i.e., morphology of the pancreatic parenchyma, pancreatic duct, and digestive tract mucosa, as well as the pancreatic reaction to the sewing material by microscopic morphometry. Results: Evidence of regeneration in the columnar-lined mucosa of main pancreatic ducts in all cases of pancreato-enterostomy was observed. The inflammatory foreign-body reaction around monofilament stitch was present without an evident infection. There were no microscopic signs of pancreatic duct damage. Total foreign body reaction varied between 138.1 μm and 207.3 μm. Conclusions: This observation supports the beneficial use of thin monofilament threads for pancreato-enteral anastomosis. There was no evidence of harmful action from gastric or intestinal juices on pancreatic remnant or the Wirsung duct.

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Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis

Cited by 232 publications

References 47 publications

Pancreatoduodenectomy - Preventing Complications

Pancreatoduodenectomy - Preventing Complications

A novel pancreatogastrostomy method using only one purse string suture and four corner mucosal sutures: early post operative surgical results

Pancreatic Anastomosis Healing

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