Safety of Pancreaticogastrostomy After Pancreaticoduodenectomy

Takano, Seigo; Ito, Yutaka; Takahashi, Tomohide; Oishi, Hitoshi; Kono, Satoru; Kawakami, Shinjiro; Nakamura, Masahiko; Yokoyama, Takeshi; Miki, Toshio; Oikawa, Takuichi; Kamo, Tomohisa

doi:10.3919/ringe1963.57.810

Cited by 6 publications

(7 citation statements)

References 4 publications

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“…Initially, 33 articles were identified. Of these, 17 were excluded because there was no comparison of surgical interventions28–39 or studies were related to duodenum‐preserving pancreatic head resection or total pancreatectomy21, 40–43. Of 16 articles identified for inclusion, five were RCTs13, 14, 18, 44, 45 and 11 OCS9, 17, 19, 20, 46–52.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy

Xiong

Altaf

Mukherjee

et al. 2012

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy

Xiong

Altaf

Mukherjee

et al. 2012

British Journal of Surgery

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“…Kapur et al ,41 have also endorsed this view. However, Takano et al ,42,45 reporting that none of their patients who underwent PG after PPPD developed a pancreatic fistula, have contradicted this concept. They also identified strong risk factors for pancreatic fistula.…”

Section: Management Of the Pancreatic Remnant After Pancreaticoduoden...mentioning

confidence: 99%

Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?

et al. 2005

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Pancreatic anastomotic leak is the single most important factor responsible for the considerable morbidity and mortality associated with pancreaticoduodenectomy. Management of the pancreatic remnant is controversially discussed, reflecting the complexity of anastomosing a pancreas of different textures to the digestive tract. A number of studies evaluating diverse options have often provided conflicting conclusions. This information is confusing particularly to those surgeons outside of large-volume centers with broad experience and to general surgeons who perform pancreatic surgery. A PubMed search with the key words pancreaticoduodenectomy, pancreatic anastomosis, pancreaticojejunostomy, pancreaticogastrostomy, and pancreatic fistula was performed. Major series of pancreatic anastomosis published between 1990 and 2002 were studied from diverse centers worldwide. Their results with regard to pancreatic fistula, morbidity, and mortality were documented. Nine series of pancreaticojejunostomy and seven series of pancreaticogastrostomy were evaluated. Eight comparative studies evaluating the two techniques were also analyzed. A single randomized controlled trial was identified among these comparative studies. Equally good results were observed with the two techniques. Other uncommon methods of management of the pancreatic remnant (duct occlusion and ligation) were also evaluated. Pancreaticojejunostomy followed by pancreaticogastrostomy are the most favored techniques. A duct-to-mucosa anastomosis is preferred over other methods. Fistula rates of less than 5%-10% should be the standard irrespective of the technique used. Unlike in the past, mortality can be reduced even in the event of an anastomotic dehiscence, and this aspect is primarily dependent on a meticulous anastomosis based on sound surgical principles rather than the method per se. Based on the information accumulated, adherence to these specific principles could ensure a safe and reliable pancreatic anastomosis with mimimal morbidity and mortality after pancreaticoduodenectomy, even in the hands of general surgeons operating outside high-volume centers.

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“…These modifications include invagination or duct-to-mucosa anastomosis, use of transanastomotic tubes for internal-external drainage of pancreatic juice, use of fibrin sealant, use of multiple transfixing mattress sutures [9] or 2 purse-string binding sutures [10], respectively. Recently published studies on PG had shown that the prevalence of pancreatic fistula ranged from 0 to 16%, and the mortality rate varied from 0 to 12.3% in studies with 41 up to 250 patients (Table 2) [7, 14–23]. However, in these studies, the definition of pancreatic fistula was very heterogeneous and mostly not well defined.…”

Section: Discussionmentioning

confidence: 99%

A Simple and Safe Anastomosis for Pancreatogastrostomy Using One Binding Purse-String and Two Transfixing Mattress Sutures

Bartsch

Langer

Kanngießer

et al. 2012

International Journal of Surgical Oncology

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Pancreatic anastomotic leakage remains a persistent problem after pancreaticoduodenectomy (PD), especially in the presence of a soft, nonfibrotic pancreas. A modified technique for pancreatogastrostomy was devised, which combines one binding purse-string and two transfixing mattress sutures between the pancreatic stump and the posterior gastric wall. This technique was applied in 35 patients after PD for malignant and benign diseases of whom 10 (28.6%) had a soft pancreas. Median time for the anastomosis was 18 minutes. Operative mortality was zero, and morbidity was 34.3%. Three (8.6%) patients developed a pancreatic fistula (2 type A, 1 type B) as classified according to the International Study Group on pancreatic fistula. All fistulas resolved without further intervention. The described technique is a simple and safe reconstruction procedure after PD that warrants further evaluation.

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Safety of Pancreaticogastrostomy After Pancreaticoduodenectomy

Cited by 6 publications

References 4 publications

Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy

Systematic review and meta-analysis of outcomes after intraoperative pancreatic duct stent placement during pancreaticoduodenectomy

Pancreatic Anastomoses after Pancreaticoduodenectomy: Do We Need Further Studies?

A Simple and Safe Anastomosis for Pancreatogastrostomy Using One Binding Purse-String and Two Transfixing Mattress Sutures

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