2018
DOI: 10.1002/bjs.10727
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Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

Abstract: Background:The postoperative pancreatic fistula (POPF) rate for duct-to-mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct-to-mucosa versus invagination pancreaticojejunostomy.Methods: Patients were stratified by pancreatic texture and diameter of the main pancreatic duct and randomized to the duct-to-mucosa or invagination group. The primary endpoint was the rate of clinically relevant POPF (defined as grade B or C). … Show more

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Cited by 71 publications
(74 citation statements)
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“…The outcome measures of the present trial were adapted retrospectively according to the new definition of POPF, but the incidence of biochemical leakage was kept in the report in order to provide a complete picture of the tightening capacity of fibrin sealant patches. The proportion of patients with biochemical leakage was significantly higher here than reported previously, whereas the incidence of grade B and C POPF was not. The authors are not able to provide a conclusive explanation for this as the participating centres have a high annual caseload of pancreatic resections, with pancreatojejunostomy performed according to general standards, with little variation.…”
Section: Discussioncontrasting
confidence: 87%
“…The outcome measures of the present trial were adapted retrospectively according to the new definition of POPF, but the incidence of biochemical leakage was kept in the report in order to provide a complete picture of the tightening capacity of fibrin sealant patches. The proportion of patients with biochemical leakage was significantly higher here than reported previously, whereas the incidence of grade B and C POPF was not. The authors are not able to provide a conclusive explanation for this as the participating centres have a high annual caseload of pancreatic resections, with pancreatojejunostomy performed according to general standards, with little variation.…”
Section: Discussioncontrasting
confidence: 87%
“…The pancreatic texture was assessed and classified as soft or hard by an experienced surgeon (Dr Liu Rong) during operation according to a previous study . The main pancreatic duct (MPD) was considered small if it measured less than 3 mm during operation as described by Senda et al .…”
Section: Methodsmentioning
confidence: 99%
“…To reduce POPF incidence after PD, numerous pancreatic anastomotic methods have been proposed and studied, and pancreaticojejunostomy (PJ) is the most commonly performed anastomosis among them . Although various anastomotic techniques have been devised to improve the outcome of PD, the best anastomotic technique for PJ to minimize POPF is still controversial . In this study, we present novel single‐layer continuous suture (SCS), a safe and effective technique for PJ for RPD based on our experience in a high‐volume robotic center.…”
Section: Introductionmentioning
confidence: 99%
“…Although the operative mortality after pancreaticoduodenectomy has decreased to < 5%, the incidence of postoperative morbidity remains as high as 60% . Of the many complications after pancreaticoduodenectomy, postoperative pancreatic fistula is the most common and severe one, the incidence of which ranges from 5–30%. This is associated with many other clinically relevant problems including sepsis, hemorrhage, and death .…”
Section: Introductionmentioning
confidence: 99%
“…7 Surgeon's experience and techniques independently influenced the overall and anastomosis relevant morbidity. Herein, various surgical procedures have been devised to improve the outcome of pancreaticojejunostomy 1,4 and biliojejunostomy. 7 However, in lower-volume and mediumvolume centers, the incidence of postoperative morbidity and mortality is still relatively high.…”
Section: Introductionmentioning
confidence: 99%