Pancreaticojejunostomy Versus Pancreaticogastrostomy in Reconstruction Following Pancreaticoduodenectomy

Abstract

Nineteen consecutive patients, 7 male and 12 female, underwent pancreaticoduodenectomy for malignancy during the 3‐year period 1985‐88. The pancreatic remnant in the first 12 patients (Group 1) was managed alternately by pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Patients undergoing PJ and PG (6 each) were comparable in age, biochemical parameters and nature and extent of disease. Three patients, all in the PJ subgroup, died (25% mortality) due to pancreatic leak, biliary leak and hepatocellular failure. In view of the high complication rate following PJ, the remaining 7 patients (Group 11) underwent PG. For patients undergoing PG, the hospital stay was shorter, complications were fewer and there was no anastomotic leak or death (0% mortality). This study represents the first attempt at comparison of PJ with PG in reconstruction following the Whipple procedure by the same team. The results suggest that PG deserves wider application.

Pancreaticoduodenectomy: Does Preoperative Biliary Drainage, Method of Pancreatic Reconstruction or Age Influence Perioperative Outcome? A Retrospective Study of 104 Consecutive Cases

“…Many retrospective studies support our finding of a reduced rate of anastomotic leak when a PG is used 28,29 . Other potential advantages of PG over PJ reported by non‐randomized studies but not confirmed by our own include reduced mortality, 29–31 reoperation, 28,30 DGE, 30 bile leak 30 and length of stay 28 . Two randomized trials have compared PG to PJ with respect to postoperative outcomes.…”

“…The major source of morbidity and potential mortality after surgery is pancreatic fistula, which is caused by difficulties associated with the pancreatic anastomosis. Pancreaticogastrostomy (PG) has become popular in many centres as an alternative to pancreaticojejunostomy (PJ) 28–35 …”

Pancreaticojejunostomy versus Pancreaticogastrostomy after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

“…Overall, 26 articles describing 3,752 patients were identified for the meta-analysis: 22 OCSs (n = 3, 199 patients) [35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56] and 4 RCTs (n = 553 patients) [10,57,58,59]. A total of 1,922 patients underwent PG (RCTs n = 276 patients, OCSs n = 1,646 patients), whilst 1,830 patients underwent PJ (RCTs n = 277 patients, OCSs n = 1,553 patients).…”

“…Duffas et al [58] preferred using internal pancreatic ductal stents in their RCT, whilst Fernández-Cruz et al [10] also used similar internal ductal stents consistently in their patients. Eight OCSs reported the use of pancreatic ductal stent in some of patients at the surgeons' discretion [35,36,43,47,51,53,55,56]. …”

Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study

“…Several studies have compared pancreaticojejunostomy (PJ) and pancreaticogasrostomy (PG) with respect to the incidence of POPF. Published single institutional studies have favored PG over PJ [8,9]. A large meta-analysis has shown a significantly lower incidence of pancreatic fistula after PG as compared to end-to-end or end-to-side PJ [10].…”