Systematic use of isolated pancreatic anastomosis after pancreatoduodenectomy: Five years of experience with zero mortality

Machado, Marcel Autran

doi:10.1016/j.ejso.2016.05.023

Cited by 18 publications

(9 citation statements)

References 39 publications

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“…A biliary Ttube was inserted in 91% of patients in group 1° and rarely (7%) in group 2°, with the rationale that the diversion of biliary secretions away from pancreatic drainage may avoid activation of pancreatic enzymes and therefore protect the healing process of the PJ [25]. Other authors subsequently suggested reconstruction on dual loop (Roux-en-Y) [26,27].…”

Section: Discussionmentioning

confidence: 99%

Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

Zurleni

Olmetti

Marzoli

et al. 2020

Preprint

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Background:Pancreaticoduodenectomy remains the gold standard for management of patients with pancreatic head and periampullary neoplasms. Despite the low mortality, overall morbidity remains high, principally due to the development of a clinically relevant postoperative pancreatic fistula (CR-POPF).The aim of the present study is to compare rates of CR-POPF in two groups of patients treated with two different pancreaticojejunostomy techniques. Methods:Among 264 consecutive patients submitted to surgery for pancreatic neoplasm, 142 pancreaticoduodenectomies with end-to-side pancreaticojejunostomy were analysed. The first group of patients underwent a direct mucosa-to-mucosa anastomosis as described by Longmire and Traverso. In the second group, a duct-to-mucosa anastomosis with an outer seromuscolar and inner full thickness layer as described by Z’graggen, Shrikhande and Buchler was performed. Results:Mortality was 2,8% in the first group (2/71) and zero in the second. In group 1°, 48.5% of patients suffered one or more grade II-V Clavien-Dindo complications; in group 2°, complications were observed in 26,7% of patients. Clinically relevant POPF occurred in 12 patients in group 1° (17%) and in 4 patients in group 2° (5,6%). Conclusions:Changing pancreaticojejunostomy techniques may produce different outcomes. In our experience, a standardized duct-to-mucosa anastomosis, as performed in group 2, significantly reduced the rate of CR-POPF.

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Section: Discussionmentioning

confidence: 99%

Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

Zurleni

Olmetti

Marzoli

et al. 2020

Preprint

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“…However, these studies were performed with few patients or had poor methodology. Others propose the preparation of an isolated Roux‐en‐Y loop for the pancreatojejunostomy. Some even suggest reconstructing the intestine in a single loop but starting with the gastric anastomosis, followed by the pancreatic anastomosis and ending with the biliary anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial)

Busquets

Martín

Fabregat

et al. 2019

Journal of British Surgery

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Background Delayed gastric emptying (DGE) is the most important cause of an extended hospital stay after pancreatoduodenectomy. Reports suggest that a Roux‐en‐Y gastroenteric anastomosis may have lower incidence of DGE than a Billroth II reconstruction. The primary aim of this RCT was to compare Billroth II (single loop) and Roux‐en‐Y (double loop) after pancreatoduodenectomy to determine whether Roux‐en‐Y reconstruction is associated with a lower incidence of DGE. Secondary endpoints were postoperative complications. Methods This was a randomized unblinded single‐centre trial without masked evaluation of the main outcome. Patients undergoing pancreatoduodenectomy between 2013 and 2015 were randomized to undergo one of two types of gastroenteric anastomosis for reconstruction. Results A total of 80 patients were randomized, 40 in each group. The incidence of DGE was the same in patients undergoing Billroth II or Roux‐en‐Y gastroenteric anastomosis (both 18 of 40 patients; P = 1·000). The grade of DGE was also similar in the Billroth II and Roux‐en‐Y groups (grade A, both 10 of 40; grade B, 5 of 40 versus 6 of 40; grade C, 3 of 40 versus 2 of 40; P = 0·962). The mortality rate was 3 per cent, with no significant difference between the two groups. There were no differences in the overall rate of postoperative morbidity, relaparotomy rate or duration of hospital stay. Conclusion The incidence and severity of DGE does not differ between single‐ or double‐loop gastroenteric anastomosis performed after pancreatoduodenectomy. Registration number: NCT00915863 (http://www.clinicaltrials.gov).

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“…In all reported cases the definitive treatment was surgical exploration with resection of the jejunum and stomach [1,3], total pancreatectomy [4] or reduction of the intussuscepted loop [2]. However, in our case the reconstruction of the alimentary tract was different, and we used two jejunal loops [5]. Therefore, the intussusception attained only the hepaticojejunostomy and its progression was halted by the bile duct, making this acute complication a limited one.…”

Section: Surgical Treatment Is Often Necessary In Cases Of Intussusceptionmentioning

confidence: 91%

“…Multidisciplinary team decided for upfront surgery. An open pancreato-duodenectomy with isolated pancreatic loop was performed as previously reported by our team [5]. Patient recovery was uneventful, and he was discharged on the 8th postoperative day.…”

Section: Clinical Imagementioning

confidence: 93%

Hepaticojejunal Intussusception After Pancreatoduodenectomy

Mcc¹,

Rb²,

Es³

et al. 2021

COS

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Systematic use of isolated pancreatic anastomosis after pancreatoduodenectomy: Five years of experience with zero mortality

Abstract: The technique of isolated pancreatic anastomosis by diverting the pancreatic from biliary secretion may contribute to reducing the severity of pancreatic fistulas and therefore the severity of this complication.

Cited by 18 publications

References 39 publications

Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

Clinically Relevant Postoperative Pancreatic Fistula rates in two methods of pancreatico-jejunal anastomosis compared: Evolution of surgical technique in a single centre over time

Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial)

Hepaticojejunal Intussusception After Pancreatoduodenectomy

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