Prospective randomized controlled trial of omental roll‐up technique on pancreatojejunostomy anastomosis for reducing perioperative complication in patients undergoing pancreatoduodenectomy

Tangtawee, Pongsatorn; Mingphruedhi, Somkit; Rungsakulkij, Narongsak; Suragul, Wikran; Vassanasiri, Watoo; Muangkaew, Paramin

doi:10.1002/jhbp.948

Cited by 8 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In DP, the stump was covered. A total of 13 RCTs used an artificial coverage technique 23–35 , 4 RCTs applied autologous material 1 , 36–38 , and 1 RCT used a combination of the two 39 . A total of 11 studies used fibrin-based materials, such as patches 24 , 27 , 30–32 and fibrin glue 25 , 26 , 33–35 , 39 .…”

Section: Resultsmentioning

confidence: 99%

“…For autologous coverage, the ligamentum teres hepatis, the ligamentum falciforme, the omentum, and the seromuscular surface of the first jejunal loop were used. A total of 5 RCTs covered the anastomosis after PD 23–26 , 36 , 12 RCTs included patients after DP 1 , 27–35 , 37 , 38 , and 1 RCT included patients after PD and DP 39 . When a PD was performed, most anastomoses were fashioned using a double-layered duct-to-mucosa technique.…”

Section: Resultsmentioning

confidence: 99%

“…Out of 12 studies, 7 studies performed selective duct closure in DP 1 , 28 , 31–34 , 37 . An internal stent of the pancreatojejunostomy was used in two studies 23 , 36 and prophylactic somatostatin analogues were applied in one RCT after PD 25 and in another RCT after DP 37 . At least 13 RCTs identified the pancreatic texture and ductal diameter as prognostic factors and stratified their analysis accordingly 23–33 , 36 , 38 .…”

Section: Resultsmentioning

confidence: 99%

“…An internal stent of the pancreatojejunostomy was used in two studies 23 , 36 and prophylactic somatostatin analogues were applied in one RCT after PD 25 and in another RCT after DP 37 . At least 13 RCTs identified the pancreatic texture and ductal diameter as prognostic factors and stratified their analysis accordingly 23–33 , 36 , 38 . The general characteristics of the included studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…This was also reflected in the present data. Only 3 studies were able to show a statistically significant benefit 23 , 29 , 34 , whereas 10 studies were only able to produce a statistical trend favouring coverage 1 , 25–28 , 30 , 32 , 36–38 . With regard to mortality, the lack of power was even more noticeable.…”

Section: Discussionmentioning

confidence: 95%

See 4 more Smart Citations

Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials

Walber,

Antony,

Strothmann

et al. 2024

BJS Open

View full text Add to dashboard Cite

Background Postoperative pancreatic fistulas remain a driver of major complications after partial pancreatectomy. It is unclear whether coverage of the anastomosis or pancreatic remnant can reduce the incidence of postoperative pancreatic fistulas. The aim of this study was to evaluate the effect of autologous or artificial coverage of the pancreatic remnant or anastomosis on outcomes after partial pancreatectomy. Methods A systematic literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to March 2024. All RCTs analysing a coverage method in patients undergoing partial pancreatoduodenectomy or distal pancreatectomy were included. The primary outcome was postoperative pancreatic fistula development. Subgroup analyses for pancreatoduodenectomy or distal pancreatectomy and artificial or autologous coverage were conducted. Results A total of 18 RCTs with 2326 patients were included. In the overall analysis, coverage decreased the incidence of postoperative pancreatic fistulas by 29% (OR 0.71, 95% c.i. 0.54 to 0.93, P < 0.01). This decrease was also seen in the 12 RCTs covering the remnant after distal pancreatectomy (OR 0.69, 95% c.i. 0.51 to 0.94, P < 0.02) and the 4 RCTs applying autologous coverage after pancreatoduodenectomy and distal pancreatectomy (OR 0.53, 95% c.i. 0.29 to 0.96, P < 0.04). Other subgroup analyses (artificial coverage or pancreatoduodenectomy) showed no statistically significant differences. The secondary endpoints of mortality, reoperations, and re-interventions were each affected positively by the use of coverage techniques. The certainty of evidence was very low to moderate. Conclusion The implementation of coverage, whether artificial or autologous, is beneficial after partial pancreatectomy, especially in patients undergoing distal pancreatectomy with autologous coverage.

show abstract