Characterization and Optimal Management of High-risk Pancreatic Anastomoses During Pancreatoduodenectomy

Ecker, Brett L.; McMillan, Matthew T.; Asbun, Horacio J.; Ball, Chad G.; Bassi, Claudio; Beane, Joal D.; Behrman, Stephen W.; Berger, Adam C.; Dickson, Euan J.; Bloomston, Mark; Callery, Mark P.; Christein, John D.; Dixon, Elijah; Drebin, Jeffrey A.; Castillo, Carlos Fernández del; Fisher, William E.; Fong, Zhi Ven; Haverick, Ericka; Hollis, Robert H.; House, Michael G.; Hughes, Steven J.; Jamieson, Nigel B.; Javed, Ammar A.; Kent, Tara S.; Kowalsky, Stacy J.; Kunstman, John W.; Malleo, Giuseppe; Poruk, Katherine E.; Salem, Ronald R.; Schmidt, Carl; Soares, Kevin C.; Stauffer, John; Valero, Vicente; Velu, Lavanniya Kumar Palani; Watkins, Amarra A.; Wolfgang, Christopher L.; Zureikat, Amer H.; Vollmer, Charles M.

doi:10.1097/sla.0000000000002327

Cited by 125 publications

(97 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These data support the need for routine performance of pancreatico-enteric anastomosis following PD. However, there is no conclusive evidence in literature that any technique is better than the other (7) except in the setting of a high-risk anastomosis (by FRS score) wherein a PJ would be preferred to a PG (62). There is no evidence to support the routine use of stents, fibrin glue or omental wrapping.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic surgeons should also familiarise themselves with the various fistula mitigating strategies and the evidence to back their use. Such knowledge is likely to prove useful when faced with a difficult to manage pancreatic stump requiring reconstruction (62).…”

Section: Discussionmentioning

confidence: 99%

“…A multinational analysis has revealed that PG is associated with a significantly higher clinically-relevant POPF rate as compared to PJ (62) in anastomoses regarded as high-risk by the Fistula Risk Score (FRS) (63). The use of mitigation strategies such as selective prophylactic drainage, and the omission of octreotide and internal stents, however, may help reduce the risks associated with the performance of a PG (64).…”

Section: Pg Vs Pjmentioning

confidence: 99%

See 2 more Smart Citations

Different types of pancreatico-enteric anastomosis

Barreto¹,

Shukla²

2017

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

The pancreatico-enteric anastomosis has widely been regarded as the 'Achilles heel' of the modern day, single-stage, pancreatoduodenectomy (PD). A review of the literature was carried out to address the evolution of the pancreatico-enteric anastomosis following PD, the spectrum of anastomoses performed around the world, and finally present the current evidence in support of each anastomosis. Pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are the most common forms of pancreatico-enteric reconstruction following PD. There is no difference in postoperative pancreatic fistula (POPF) rates between PG and PJ, as well as individual variations, except in a high-risk anastomosis where performance of a PJ may be preferred. The routine use of glue, trans-anastomotic stents or omental wrapping is of no proven benefit. Externalised trans-anastomotic stents may have a role in mitigating the risk of a clinically relevant POPF in high-risk anastomoses. Pancreatico-enteric anastomosis is an important component of reconstruction following PD even though it is fraught with the risk of development of a POPF. Adherence to the tenets of anastomotic reconstruction and performance of a safe and reproducible anastomosis with a low clinically-relevant POPF rate remain the mainstay of achieving the best outcomes. Appropriate selection and opportune use of fistula mitigation strategies may help provide optimal outcomes when faced with the need to perform a high-risk pancreatico-enteric anastomosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Pg Vs Pjmentioning

confidence: 99%

See 1 more Smart Citation

Different types of pancreatico-enteric anastomosis

Barreto¹,

Shukla²

2017

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

show abstract

“…Significant efforts have been made to reduce the risk of POPF by using a number of approaches including using different anastomotic techniques (i.e. dunking methods and pancreato‐gastrostomy), pancreatic duct stents (internal and external), somatostatin analogues and drains . All of the above‐mentioned strategies may be beneficial in anastomoses at high risk of leakage, but may not be necessary in low‐risk anastomoses.…”

Section: Introductionmentioning

confidence: 99%

Predicting post‐operative pancreatic fistulae using preoperative pancreatic imaging: a systematic review

Barreto

Dirkzwager

Windsor

et al. 2018

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…In einer Subgruppenanalyse konnte aber gezeigt werden, dass die externe Pankreasgangdrainage zu einem verringerten Auftreten von POPF führt. Eine neue multinationale retrospektive Studie hat ebenfalls das Auftreten der POPF im Zusammengang mit der Verwendung von interner und externer Pankreasgangdrainage untersucht[21]. Hier konnte gezeigt werden, dass bei risikoreichen Pankreasanastomosen die Verwendung von externen Pankreasgangdrainagen zu einer Verringerung der POPF-Rate führt.…”

unclassified