Pancreaticojejunostomy—a review of modern techniques

Grudzińska, Ewa; Mrowiec, Sławomir

doi:10.1007/s00423-020-01855-6

Cited by 47 publications

(28 citation statements)

References 52 publications

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“…Until now, the optimal reconstruction technique for PJ after PD has remained controversial 59 . This systematic review and meta-analysis not only made a comparison between BA and non-Blumgart PJ, but it also compared BA with CWA, KA and invagination PJ.…”

Section: Discussionmentioning

confidence: 99%

Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Wei

Xia

et al. 2020

Sci Rep

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Postoperative pancreatic fistula (POPF) is the most serious complication after pancreaticoduodenectomy (PD). Recently, Blumgart anastomosis (BA) has been found to have some advantages in terms of decreasing POPF compared with other pancreaticojejunostomy (PJ) using either the duct-to-mucosa or invagination approach. Therefore, the aim of this study was to examine the safety and effectiveness of BA versus non-Blumgart anastomosis after PD. The PubMed, EMBASE, Web of Science and the Cochrane Central Library were systematically searched for studies published from January 2000 to March 2020. One RCT and ten retrospective comparative studies were included with 2412 patients, of whom 1155 (47.9%) underwent BA and 1257 (52.1%) underwent non-Blumgart anastomosis. BA was associated with significantly lower rates of grade B/C POPF (OR 0.38, 0.22 to 0.65; P = 0.004) than non-Blumgart anastomosis. Additionally, in the subgroup analysis, the grade B/C POPF was also reduced in BA group than the Kakita anastomosis group. There was no significant difference regarding grade B/C POPF in terms of soft pancreatic texture between the BA and non-Blumgart anastomosis groups. In conclusion, BA after PD was associated with a decreased risk of grade B/C POPF. Therefore, BA seems to be a valuable PJ to reduce POPF comparing with non-Blumgart anastomosis.

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Section: Discussionmentioning

confidence: 99%

Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Wei

Xia

et al. 2020

Sci Rep

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“…The use of barbed sutures has proven to be safe and timesaving in general surgery and urology [19][20][21], but its use has not yet been reported in recent systematic reviews of PJ techniques [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Several techniques of pancreatic anastomosis have been proposed, including pancreato-gastrostomy (PG) and different techniques of PJ, including duct to mucosa and invagination [7][8][9][10][11][12]. Undoubtedly, one of the limitations of RAS for PD relates to the lack of a tactile feedback, since this may contribute to iatrogenic pancreatic parenchymal laceration during knots tying or from suboptimal suture line tension during continuous suturing [13].…”

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confidence: 99%

Use of barbed suture without fashioning the “classical” Wirsung-jejunostomy in a modified end-to-side robotic pancreatojejunostomy

et al. 2020

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Background The treatment of the pancreatic stump is a critical step of pancreatoduodenectomy (PD). Robot-assisted surgery (RAS) can facilitate minimally invasive challenging abdominal procedures, including pancreatojejunostomy. However, one of the major limitations of RAS stems from its lack of tactile feedback that can lead to pancreatic parenchyma laceration during knot tying or during traction on the suture. Moreover, a Wirsung-jejunostomy is not always easy to execute, especially in cases with small diameter duct. Herein, we describe and video-report the technical details of a robotic modified end-to-side invaginated robotic pancreatojejunostomy (RmPJ) with the use of barbed suture instead of the “classical” Wirsung-jejunostomy. Methods The RmPJ technique consists of a double layer of absorbable monofilament running barbed suture (3–0 V-Loc), the outer layer is used to invaginate the pancreatic stump. Thereafter, a small enterotomy is made in the jejunum exactly opposite to the location of the pancreatic duct for stent insertion (usually 5 Fr) inside the duct. The internal layer provides a second barbed running suture placed between the pancreatic capsule/parenchyma and the jejunal seromuscular layer. Results A total of 14 patients underwent robotic PD with RmPJ at our Institution. The mean console time was (281.36 ± 31.50 min), while the mean operative time for fashioning the RmPJ was 37.31 ± 7.80 min. Ten out of 14 patients were discharged within postoperative day 8. No clinically relevant pancreatic fistulas were encountered, while two patients developed biochemical leaks. Conclusions RmPJ is feasible and reproducible irrespective of pancreatic duct size and parenchyma, and can enhance the surgical workflow of this operation. Specifically, the use of barbed sutures allows the exploitation of the potential advantages of the RAS, while minimizing the negative effect caused by the main disadvantage of the robotic approach, its absence of tactile feedback, by ensuring uniform tension on the continuous suture lines used, especially during the reconstructive phase of the operation.

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“…In 1972, Traverso and Longmire proposed a modification of the conventional procedure, the pylorus-preserving pancreaticoduodenectomy technique, in which the duodenum is cut about 2-3 cm below the pylorus: this results in a significant decrease in the incidence of postoperative dumping, marginal ulceration, and bile reflux gastritis [93]. At the end of the procedure, continuity of the pancreatic, biliary, and gastrointestinal tract systems is reestablished through pancreatojejunostomy between the pancreatic stump or the main pancreatic duct and the small intestine [87,94].…”

Section: Pancreaticoduodenectomy Techniquesmentioning

confidence: 99%

Endocrine and Metabolic Insights from Pancreatic Surgery

Mezza

Cefalo

Cinti

et al. 2020

Trends in Endocrinology & Metabolism

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Although it is well established that diabetes can also develop as a result of diseases or maneuvers on the exocrine pancreas, the complex relationship between glucose disorders and underlying pancreatic disease is still debated. There is evidence that several features linked to pancreatic diseases can modify endocrine and metabolic conditions before and after surgery. However, pancreatic surgery provides a rare opportunity to correlate in vivo endocrine and metabolic pathways with ex vivo pancreatic samples, to examine the endocrine and metabolic effects of acute islet removal, and finally to clarify the pathogenesis of diabetes. This approach could therefore represent a unique method to shed light on the molecular mechanisms, predicting factors, and metabolic consequences of insulin resistance, islet plasticity, β cell failure, and type 2 diabetes.

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Pancreaticojejunostomy—a review of modern techniques

Cited by 47 publications

References 52 publications

Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Blumgart anastomosis reduces the incidence of pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis

Use of barbed suture without fashioning the “classical” Wirsung-jejunostomy in a modified end-to-side robotic pancreatojejunostomy

Endocrine and Metabolic Insights from Pancreatic Surgery

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