Duct-to-mucosa versus other types of pancreaticojejunostomy for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy

Hai, Hua; Li, Zhuyin; Zhang, Ziwei; Cheng, Yao; Liu, Zuojin; Gong, Jianping; Deng, Yong

doi:10.1002/14651858.cd013462.pub2

Cited by 10 publications

(13 citation statements)

References 67 publications

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“…As an important complication of LPD, PF is closely associated with patient prognosis. [26–28] Our results showed that patients with PF had a higher probability of abdominal infection, an increased number of individual complications, and a higher rate of reoperation. The superimposition of these factors increases the length of hospital stay and costs, and increases the psychological and economic burdens on patients.…”

Section: Discussionmentioning

confidence: 72%

An analysis of risk factors for clinically relevant pancreatic fistulas after laparoscopic pancreaticoduodenectomy

Chen

Zheng

et al. 2023

Medicine

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This study aimed to explore the risk factors of clinically relevant pancreatic fistulas (PF) after laparoscopic pancreaticoduodenectomy (LPD). The clinical data of 80 patients who underwent pancreaticoduodenectomy in our hospital were retrospectively analyzed. The potential risk factors for PF after LPD were determined using univariate and multivariate logistic regression analyses. Results from the univariate analyses showed that the pancreatic duct diameter (P < .001), pancreatic texture (P < .001), abdominal infection (P = .002), and reoperation (P < .001) were associated with clinically relevant PF. Results from the multivariate logistic regression analysis showed that the pancreatic duct diameter (P = .002) and pancreatic texture (P = .016) were significant risk factors for clinically relevant PF. Based on this study, the pancreatic duct diameter and pancreatic texture are independent risk factors for clinically relevant PF after LPD.

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Section: Discussionmentioning

confidence: 72%

An analysis of risk factors for clinically relevant pancreatic fistulas after laparoscopic pancreaticoduodenectomy

Chen

Zheng

et al. 2023

Medicine

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“…Data about the outcomes of different techniques for distal pancreatic stump anastomoses are coming mainly from patients with PD [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 44 , 45 , 46 ], while a minority of studies comparatively explore patients with CP [ 12 , 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mainly, there are two types of jejunal anastomoses of the distal pancreatic stump after PD or CP: duct-to-mucosa and invagination techniques [ 11 , 25 , 28 , 31 , 42 , 47 ] ( Figure 3 and Figure 4 ). The invagination technique is easier to perform.…”

Section: Discussionmentioning

confidence: 99%

“…Various reconstruction techniques have been proposed for the distal pancreatic stump to reduce POPF rates after CP and pancreaticoduodenectomy (PD) for both anastomoses with the jejunum and the stomach [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Although many studies are comparing the outcomes of different types of anastomoses of the distal pancreatic stump after PD [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], for CP, the data are scarce. Thus, to date, only three studies have compared the distal pancreatic stump anastomoses with the jejunum vs. the stomach after CP [ 12 , 33 , 34 ], and one study has compared pancreatojejunostomy with end-to-end Wirsung duct anastomoses [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

Dumitraşcu

Popescu

2023

JPM

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(1) Background: The jejunum is primarily used for distal pancreatic stump anastomoses after central pancreatectomy (CP). The study aimed to compare duct-to-mucosa (WJ) and distal pancreatic invagination into jejunum anastomoses (PJ) after CP. (2) Methods: All patients with CP and jejunal anastomoses (between 1 January 2002 and 31 December 2022) were retrospectively assessed and compared. (3) Results: 29 CP were analyzed: WJ—12 patients (41.4%) and PJ—17 patients (58.6%). The operative time was significantly higher in the WJ vs. PJ group of patients (195 min vs. 140 min, p = 0.012). Statistically higher rates of patients within the high-risk fistula group were observed in the PJ vs. WJ group (52.9% vs. 0%, p = 0.003). However, no differences were observed between the groups regarding the overall, severe, and specific postpancreatectomy morbidity rates (p values ≥ 0.170). (4) Conclusions: The WJ and PJ anastomoses after CP were comparable in terms of morbidity rates. However, a PJ anastomosis appeared to fit better for patients with high-risk fistula scores. Thus, a personalized, patient-adapted technique for the distal pancreatic stump anastomosis with the jejunum after CP should be considered. At the same time, future research should explore gastric anastomoses’ emerging role.

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“…The available data do not show any definitive advantages for one specific type of gastrointestinal reconstruction technique after pancreatoduodenectomy, compared with other techniques [ 5 , 6 , 7 ].…”

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confidence: 99%

State of the Art in Pancreatic Surgery: Some Unanswered Questions

Perra¹,

Porcu²

2022

JCM

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Duct-to-mucosa versus other types of pancreaticojejunostomy for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy

Cited by 10 publications

References 67 publications

An analysis of risk factors for clinically relevant pancreatic fistulas after laparoscopic pancreaticoduodenectomy

An analysis of risk factors for clinically relevant pancreatic fistulas after laparoscopic pancreaticoduodenectomy

Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

State of the Art in Pancreatic Surgery: Some Unanswered Questions

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