One-layer versus two-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: study protocol for a randomized controlled trial

Pan, Shubo; Geng, Wei; Zhou, Dachen; Chen, Jiangming; Zhao, Hua-Lu; Liu, Fubao; Xie, Sheng‐Xue; Hou, Hui; Zhao, Yupei; Xie, Kun; Wang, Guobin; Geng, Xiaoping

doi:10.1186/s13063-016-1517-8

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…According to the literature search, a greater focus on single-layer PJ has been reported in China, [8,[12][13][14] and the incidence of POPF and other complications was lower in single-layer PJ compared with double-layer in some studies. [14][15][16][17] Single-layer anastomosis is deemed simpler, faster, and less traumatic to the pancreas than double-layer PJ; however, there are no randomized controlled trials (RCTs) to validate this superiority. Furthermore, even in single-layer PJ, there are continuous and interrupted techniques, and no clinical controlled studies have been reported for these two suturing methods, while similar RCTs have been reported for the small intestine, mitral valve, and obstetric tract surgery.…”

Section: Discussionmentioning

confidence: 99%

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Wei

Zhang

et al. 2022

Journal of Pancreatology

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Background: Pancreaticoduodenectomy (PD) has been widely applied in general hospitals in China; however, there is still a lack of unified standards for each surgical technique and procedure. This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method: A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy. The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results: A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of mainland China. The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%. Generally, laparoscopic PD was performed less often than open PD. Child and Whipple reconstructions accounted for 70% and 26%, respectively. The sequence of pancreatoenteric, biliary-enteric, and gastrointestinal reconstruction accounted for 84% of cases. In pancreatoenteric anastomosis, double-layer anastomosis is the most commonly employed type, accounting for approximately 67%, while single-layer anastomosis accounts for 30%. Of the double-layer anastomoses, duct-to-mucosa/dunking (94%/4%) pancreatojejunostomy was performed with duct-mucosa using the Blumgart method (39%) and Cattel-Warren (29%), with continuous/interrupted sutures in the inner layer (69%/31%) and continuous/interrupted sutures in the outer layer (53%/23%). In single-layer anastomosis, continuous/ interrupted sutures accounted for 41%/45%. In hepatojejunostomy, single-layer/double-layer suture accounted for 79%/4%, and continuous/interrupted suture accounted for 75%/9%. Forty-six percent of the responding units had not applied double-layer biliaryintestinal anastomosis in the last 3 years, 75% of the responding surgeons chose the anastomosis method according to bile duct diameter, with absorbable/non-absorbable suture accounting for 86%/12%. PD/pylorus-preserving PD accounted for 79%/11% of gastrojejunostomy (GJ) cases, the distance between GJ and hepaticojejunostomy < 30, 30-50, and > 50 cm were 11%, 75%, and 14%, respectively. Antecolic/retrocolic GJ accounted for 71%/23% of cases. Twenty-two percent of GJ cases employed Braun anastomosis, while 55% and 19% of GJ cases used linear cutting staplers/tube-type staplers, respectively; 60%/14% were reinforced/ not reinforced via manual suturing after stapler anastomosis. Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures (91%/9%). Significant differences in reconstruction techniques were detected between different volumes of PD procedures (<100/year and >100/year), regions with different economic development levels, and between north and south China.Conclusion: Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals. Corresponding prospective clinical studies are needed t...

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Section: Discussionmentioning

confidence: 99%

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Wei

Zhang

et al. 2022

Journal of Pancreatology

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“…Another publication showed that single layer sutures, going from the edge of the stump to the MPD prevent pancreatic fistula better than sutures passing only through a part of the pancreatic parenchyma [39]. The advantages of single-and double-layer anastomoses are about to be assessed in prospective randomized trials [40].…”

Section: Modifications Of the Duct-to-mucosa Techniquementioning

confidence: 99%

Pancreaticojejunostomy—a review of modern techniques

Grudzińska

Mrowiec

2020

Langenbecks Arch Surg

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Background Pancreaticojejunal anastomosis is one of the most demanding procedures in surgery. Up to now, no technique has been proven to reduce the incidence of POPF when compared to the other methods. Purpose The aim of this review was to provide a concise and illustrated description of the most recent methods of pancreaticojejunostomy. Their development was directly related to the still ongoing search by surgeons for such a technique of anastomosis that would eliminate the problem of POPF. Conclusions Knowledge of various techniques of anastomosis may help the surgeon to find the most suitable and optimal method of pancreatic-intestinal anastomosis for the patient.

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

Hai

Zhang

et al. 2022

Cochrane Database of Systematic Reviews

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One-layer versus two-layer duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: study protocol for a randomized controlled trial

Cited by 7 publications

References 21 publications

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Pancreaticojejunostomy—a review of modern techniques

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

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