Duct-to-Mucosa Versus Invagination Pancreaticojejunostomy Following Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis

Hua, Jie; He, Zhigang; Qian, Daohai; Meng, Hui; Zhou, Bo; Song, Zhijun

doi:10.1007/s11605-015-2913-1

Cited by 58 publications

(35 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall morbidity and mortality rates associated with PD in adults have been extensively studied[4-6]. Reported rates have decreased over the years with improved surgical techniques and have now seemingly stabilized at a rate of 30-40% for morbidity and 1%-3% for mortality[7-9].…”

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis

Lindholm

Alkattan

Abramson

et al. 2017

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Purpose While pancreaticoduodenectomy (PD) has been extensively studied in adults, there are few data pertaining specifically to pediatric patients. We retrospectively analyzed PD-associated morbidity and mortality in pediatric patients. Methods Our analytic cohort included all consecutive patients ≤18 years of age treated at our institution from 1993-2015 who underwent PD. Patient data (demographics, disease characteristics, surgical and adjuvant treatment, length of hospital stay, and postoperative course) were extracted from the medical records. Results We identified 12 children with a median age of 9 years (7 female, 5 male). Final diagnoses were pancreatoblastoma (n=3), solid pseudopapillary tumor (n=3), neuroblastoma (n=2), rhabdomyosarcoma (n=2), and neuroendocrine carcinoma (n=2). Four patients underwent PD for resection of recurrent disease. 75% (9/12 patients) received neoadjuvant therapy. The median operative time was approximately 7 hours with a mean blood loss of 590cc. The distal pancreas was invaginated into the posterior stomach (n=3), into the jejunum (n=5) or directly sewn to the jejunal mucosa (n=4). There were no operative deaths. There were 4 patients (34%) with Grade II complications, 1 with a Grade IIIb complication (chest tube), and 1 with a Grade IV complication (re-exploration). The most common long-term morbidity was pancreas exocrine supplementation (n=10; 83%). Five patients (42%) diagnosed with either solid pseudopapillary tumor or rhabdomyosarcoma are currently alive with a mean survival of 77.4 months. Conclusion Pancreaticoduodenectomy is a feasible management strategy for pediatric pancreatic malignancies and is associated with acceptable morbidity and overall survival. Long-term outcome is most dependent on histology of the tumor. Level of Evidence IV

show abstract

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis

Lindholm

Alkattan

Abramson

et al. 2017

Journal of Pediatric Surgery

View full text Add to dashboard Cite

show abstract

“…To date, randomized controlled trials conducted to identify a better method for performing PJ have failed to discover a technique superior to the others in terms of operation-related morbidity and mortality 816. As a result, the surgeons can choose the preferred PJ method after achieving a sufficient level of experience of the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Duct-to-mucosa PJ may be a reasonable choice because it has a lower rate of clinically relevant POPF,17 although some studies have concluded otherwise 818. Since Warren and Cattell described a detailed method for duct-to-mucosa PJ in 1956, many technical modifications have been reported, and today it appears that every large volume center has its own method 16171819.…”

Section: Discussionmentioning

confidence: 99%

“…In turn, PJ can be further classified into three categories; end-to-side, duct-to-mucosa, and end-to-end invagination (dunking) 7. Numerous minor modifications to pancreatic ductal stenting and suture techniques have been suggested for each of these categories, but no one particular method has been demonstrated to be superior to the others 8910. Currently, the adoption of one particular PJ method seems to depend on the surgeon's preference and his or her experience.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures

Kim

Shin

Lee

et al. 2017

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

Pancreaticoenteric anastomosis is the origin of postoperative pancreatic fistula (POPF). Although a variety of methods have been proposed to decrease the POPF rate, randomized controlled trials performed so far have failed to demonstrate superiority of any particular method to the others. Cattell-Warren duct-to-mucosa pancreaticojejunostomy (PJ) is a widely practiced procedure. Their method is challenging, especially when the pancreatic duct is small. We assumed that the difficulty resides in the pancreatic duct becoming difficult to access when the posterior row is tied before suturing the anterior row. We have modified the duct-to-mucosa PJ so that the entire circumference of the inner layer can be sutured and tied in one-step by anchoring and retracting the anterior row. The jejunal roux-limb and pancreatic stump are positioned spatially apart, allowing enough space for free needle work. During a 13-year period, 151 patients underwent pancreaticoduodenectomy with this method, and the cumulative POPF and mortality rates were 37.1% and 4.6%, respectively. These rates were stable throughout the study period, implicating a relative independence from surgeons' experience. We believe that our method is intuitive, easy to grasp, and can be readily adopted even by surgeons not accustomed to pancreaticoduodenectomy.

show abstract

“…It not only prolongs hospital stay and in-creases healthcare costs, but also plays a central role in the development of life-threatening events such as intra-abdominal abscess and PPH [7][8][9][10] . Several surgical techniques and perioperative care have been studied in order to prevent or decrease the incidence of POPF after PD, including digestive tract reconstruction with pancreaticogastrostomy [11] , duct to mucosa or invagination pancreaticojejunostomy (PJ) [12] , prophylactic somatostatin or somatostatin analogues [13] , fibrin glue sealants [14] , and pancreatic duct stents [15] . However, even in highvolume centers, the incidence of POPF is still in the range of 9.9-28.5% [16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis

Zhang¹,

Dong²,

Liu³

et al. 2017

Dig Surg

View full text Add to dashboard Cite

Background: The aim of this study was to compare the safety and efficacy of a new technology, binding pancreaticojejunostomy (BPJ), with conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy in preventing postoperative pancreatic fistula (POPF). Methods: Randomized controlled trials and observational studies were retrieved from literature searches. Pooled OR with 95% CI for dichotomous variables and weighted mean difference with 95% CI for continuous variables were calculated. Fixed-effect and random-effect models as well as subgroup analysis were used for sensitivity analysis. Results: No statistically significant differences were found in the incidence of POPF, delayed gastric emptying, postpancreatectomy hemorrhage, reoperation, morbidity, mortality, operation time, intraoperative blood loss, blood transfusion, and hospital stay between 2 groups. However, the total costs of hospitalization and ordinary stay were higher in BPJ group (€10,513 ± €6,536 vs. €8,238 ± €4,687, p = 0.002; €7,946 ± €5,023 vs. €5,700 ± €2,902, p = 0.015, respectively). Conclusions: Our study showed BPJ was as safe as CPJ. However, no significant superiority was found in BPJ group regarding the incidence of POPF. The total costs of hospital stay were higher for patients undergoing BPJ. Surgeons can prefer to perform the digestive tract reconstruction of their choice.

show abstract

Duct-to-Mucosa Versus Invagination Pancreaticojejunostomy Following Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis

Abstract: Invagination PJ is not superior to duct-to-mucosa PJ in terms of POPF and other complications but appears to reduce clinically relevant POPF. Further well-designed RCTs that use ISGPS definition are still required before strong evidence-based recommendations can be formulated.

Cited by 58 publications

References 28 publications

Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis

Pancreaticoduodenectomy for pediatric and adolescent pancreatic malignancy: A single-center retrospective analysis

An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures

Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About