Modified pancreaticogastrostomy following pancreaticoduodenectomy

Takao, Sonshin; Shimazu, Hisaaki; Maenohara, Shigeho; Shinchi, Hiroyuki; Aikou, Takashi

doi:10.1016/s0002-9610(05)80833-5

Cited by 64 publications

(52 citation statements)

References 8 publications

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“…The anastomosis was stented through the stomach and abdominal wall. Takao et al 4 described a similar modification in which a stent is placed from the pancreatic duct, across the anastomosis, and through both posterior and anterior walls of the stomach, to drain exteriorly on to the anterior abdominal wall. Bradbeer and Johnson 16 and Ihse et al 17 have previously reported a two-layered pancreaticogastrostomy with duct-to-mucosa apposition.…”

Section: Discussionmentioning

confidence: 99%

Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy

Payne

Pain

2005

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy

Payne

Pain

2005

British Journal of Surgery

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“…In other articles, PJ was associated with a significantly higher PF rate than PG [3,4,6,11,12] . Some authors presented materials where PF rates after PG were less than 5% [6,13] or even 0% [14][15][16] . In our material only 3% of POPF was observed.…”

Section: Discussionmentioning

confidence: 99%

“…In our material only 3% of POPF was observed. Some researchers reported that soft pancreatic texture, ampullary or duodenal lesions, longer operating time, greater intraoperative blood transfusion and lower surgical volume can increase the risk of PF formation significantly [6,9,10,12,15] . In our study, parameters such as operating time, blood loss, blood transfusions or ASA class did not influence the incidence of the PF formation.…”

Section: Discussionmentioning

confidence: 99%

Results of Pancreaticogastrostomy after Pancreaticoduodenectomy in 159 Consecutive Cases

et al. 2008

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“…The first PG in humans was performed in 1944 [28] . Since then, several series with around 3800 patients have been published [29][30][31] , and their outcomes have been compared in some papers with those of PJ to determine the best reconstructive technique.…”

Section: Pancreatogastrostomymentioning

confidence: 99%

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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Modified pancreaticogastrostomy following pancreaticoduodenectomy

Cited by 64 publications

References 8 publications

Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy

Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy

Results of Pancreaticogastrostomy after Pancreaticoduodenectomy in 159 Consecutive Cases

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

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