Binding Versus Conventional Pancreaticojejunostomy After Pancreaticoduodenectomy: A Case-Matched Study

Maggiori, Léon; Sauvanet, Alain; Nagarajan, Ganesh; Dokmak, Safi; Aussilhou, B.; Belghiti, Jacques

doi:10.1007/s11605-010-1212-0

Cited by 51 publications

(36 citation statements)

References 32 publications

(57 reference statements)

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“…Some authors have named the pancreatic anastomosis the Achilles heel of pancreatic surgery [4]. Hence, numerous surgical techniques and devices have been proposed to prevent fistula formation, such as use of the duct-to-mucosa technique, binding pancreaticojejunostomy, pancreaticogastrostomy reconstruction, Roux-en-Y reconstruction, omental wrapping around the pancreaticojejunostomy, early removal of the drain, but the best technique is still a subject of debate [5,6,7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

et al. 2011

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“…However, two French studies failed to reproduce the same results. In the study by Maggiori et al [22], a conventional PJ and binding technique had a similar fistula rate, but healing of the fistula took longer in patients with PJ carried out using Peng’s technique compared to conventional PJ (29 vs. 9 days). Incidence of hemorrhage was also higher in the binding technique (6/22 vs. 0/25).…”

Section: Discussionmentioning

confidence: 99%

Blumgart’s Technique of Pancreaticojejunostomy: An Appraisal

Mishra

Saluja²,

Gupta³

et al. 2011

Dig Surg

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Background: Although mortality of Whipple’s pancreaticoduodenectomy (WPD) is reduced to <5%, morbidity still remains between 30 and 50%. Pancreaticojejunal anastomosis remains the main cause of morbidity. Blumgart anastomosis using transpancreatic U sutures has been proposed to decrease the leak rate and its associated morbidity. We analyzed the results of Blumgart anastomosis applied in consecutive cases of WPD. Methods: Of 189 patients with periampullary or pancreatic cancer admitted, 100 patients underwent WPD. Except for 2 patients (no duct identified preoperatively), all patients underwent pancreaticojejunostomy by the Blumgart anastomotic technique. The records of 98 patients were analyzed for pancreatic leak and its related complications using the definitions given by the International Study Group for Pancreatic Surgery. Results: Of 98 patients, 63 were men. The mean operative time was 390 min (270–690 min) and blood loss was 275 ml (100–1,000 ml). Overall mortality was 3.06%. The clinically significant pancreatic anastomotic failure leak was seen in only 7 (7.14%) cases (grade B, n = 4; grade C, n = 3) with one patient requiring relaparotomy due to leak. Only one patient died due to a leak-related complication. Conclusion: Blumgart pancreaticojejunal anastomosis can be routinely used for reconstruction in WPD. It is a technically simple procedure and is associated with low rates of fistula and its related complications.

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“…The results of this anastomosis were excellent in a randomized clinical trial conducted by the promoter of this technique [13] , but so far have not been confirmed in two prospective studies in 2010 [14,15] . More recently, a prospective, but not randomized, study showed that the method described by Peng is safe but is not associated with a lower frequency of PF, morbidity or mortality in comparison with the duct-to-mucosa anastomosis [16] .…”

Section: Pj By Invaginationmentioning

confidence: 92%

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

Gómez¹

2014

WJGO

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Pancreatic surgeons try to find the best technique for reconstruction after pancreatoduodenectomy (PD) in order to decrease postoperative complications, mainly pancreatic fistulas (PF). In this work, we compare the two most frequent techniques of reconstruction after PD, pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), in order to determine which of the two is better. A systematic review of the literature was performed, including major meta-analysis articles, clinical randomized trials, systematic reviews, and retrospective studies. A total of 64 articles were finally included. PJ and PG are usually responsible for most of the postoperative morbidity, mainly due to the onset of PF, being considered a major trigger of life-threatening complications such as intra-abdominal abscess and hemorrhagia. The included systematic reviews reported a significant difference only in the incidence of intraabdominal collections favouring PG. PF, delayed gastric emptying and mortality were not different. Although there was heterogeneity between these studies, all were conducted in specialized centers by highly experienced surgeons, and the surgical care was likely to be similar for all the studies. The disadvantages of PG include an increased incidence of delayed gastric emptying and of main pancreatic duct obstruction due to overgrowth by the gastric mucosa. Exocrine function appears to be worse after PG than after PJ, resulting in severe atrophic changes in the remnant pancreas. Depending on the type of PJ or PG used, the PF rate and other complications can also be different. The best method to deal with the pancreatic stump after PD remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles such as good exposure and visualization. In conclusion, up to now none of the techniques can be considered superior or be recommended as standard for reconstruction after PD. Core tip: Pancreatoduodenectomy is a technique with a high rate of morbidity and mortality. Surgeons try to find the best technique of reconstruction in order to decrease postoperative complications. We compare the two most frequent techniques of reconstruction after pancreatoduodenectomy, namely pancreatojejunostomy and pancreatogastrostomy, to determine which of the two is better. We offer a systematic review of the main papers published with all the pros and cons of each technique. The best method to deal with the pancreatic stump after pancreatoduodenectomy remains questionable. The choice of method of pancreatic anastomosis could be based on individual experience and on the surgeon's preference and adherence to basic principles, such as good exposure and visualization. TOPIC HIGHLIGHTSeptember 15, 2014|Volume 6|Issue 9|

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Binding Versus Conventional Pancreaticojejunostomy After Pancreaticoduodenectomy: A Case-Matched Study

Abstract: Results of this study showed that binding pancreaticojejunostomy after pancreaticoduodenectomy was not associated with lower postoperative pancreatic fistula and moreover seems to increase postpancreatectomy hemorrhage.

Cited by 51 publications

References 32 publications

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

Does External Pancreatic Duct Stent Decrease Pancreatic Fistula Rate after Pancreatic Resection? A Meta-Analysis

Blumgart’s Technique of Pancreaticojejunostomy: An Appraisal

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

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