Pancreatogastrostomy With Gastric Partition After Pylorus-Preserving Pancreatoduodenectomy Versus Conventional Pancreatojejunostomy

Fernández‐Cruz, Laureano; Cosa, Rebeca; Blanco, L.; López-Boado, M.Á.; Astudillo, E.

doi:10.1097/sla.0b013e31818fefc7

Cited by 187 publications

(207 citation statements)

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“…[8][9][10][11][12][13][14][15] Some of these com parisons have been summarized in recent systematic reviews and metaanalyses. [16][17][18][19][20] Observational studies sug gested that PG is a safer reconstruction than PJ, resulting in lower morbidity, including lower pancreatic leak rates and decreased postoperative mortality.…”

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confidence: 99%

In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy

et al. 2015

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In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomyBackground: It has been suggested that pancreaticogastrostomy (PG) is a safer reconstruction than pancreaticojejunostomy (PJ), resulting in lower morbidity, including lower pancreatic leak rates and decreased postoperative mortality. We com pared PJ and PG after pancreaticoduodenectomy (PD). Methods:A randomized clinical trial was designed. It was stopped with 50% accrual. Patients underwent either PG or PJ reconstruction. The primary outcome was the pancreatic fistula rate, and the secondary outcomes were overall morbidity and mor tality. We used the Student t, Mann-Whitney U and χ 2 tests for intention to treat analysis. The effect of randomization, American Society of Anesthesiologists score, soft pancreatic texture and use of pancreatic stent on overall complications and fistula rates was calculated using logistic regression.Results: Our trial included 98 patients. The rate of pancreatic fistula formation was 18% in the PJ and 25% in the PG groups (p = 0.40). Postoperative complications occurred in 48% of patients in the PJ and 58% in the PG groups (p = 0.31). There were no significant predictors of overall complications in the multivariate analysis. Only soft pancreatic gland predicted the occurrence of pancreatic fistula (odds ratio 5.89, p = 0.003). Conclusion:There was no difference in the rates of pancreatic leak/fistula, overall complications or mortality between patients undergoing PG and and those under going PJ after PD.Contexte : Selon certains, la pancréatogastrostomie (PG) est une technique de recon struction plus sécuritaire que la pancréatojéjunostomie (PJ) et entraîne une morbidité moindre, y compris un taux moins élevé de fuites pancréatiques et une mortalité post opératoire diminuée. Nous avons comparé la PJ et la PG postpancréatoduodénectomie. Méthodes :Un essai clinique randomisé a été conçu et cessé à l'atteinte d'un taux de participation de 50 %. Les patients ont subi une reconstruction par PG ou par PJ. Le paramètre principal était le taux de fistules pancréatiques et les paramètres secondaires étaient la morbidité et la mortalité globales. Nous avons utilisé les tests t de Student, U de Mann-Whitney et du χ 2 carré pour l'analyse en intention de traiter. Nous avons cal culé l'effet de la randomisation, du score de l'American Society of Anesthesiologists, de la consistance molle du pancréas et du recours à l'endoprothèse pancréatique sur les com plications globales et les taux de fistules à l'aide d'une analyse de régression logistique.Résultats : Notre essai a regroupé 98 patients. Le taux de fistules pancréatiques a été de 18 % dans le groupe soumis à la PJ et de 25 % dans le groupe soumis à la PG (p = 0,40). Des complications postopératoires sont survenues chez 48 % des patients du groupe soumis à la PJ et chez 58 % du groupe soumis à la PG (p = 0,31). Aucun pré dicteur significatif des complications globales n'est ressorti à l'analyse multivariée. Seule l...

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In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy

et al. 2015

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“…However, there are some limitations in this meta-analysis as follows; (I) the type of intervention and the indications for surgery which are different among seven RCTs may lead to different results; (II) the definition of pancreatic fistula varied among these RCTs may cause the different decision of pancreatic fistula among each institution. There were nine RCTs to examine that PG reduces the incidence of pancreatic fistula comparing PJ ( Table 1) (17)(18)(19)(20)(21)(22)(23)(24)(25). Afterward, a multicenter prospective randomized controlled trial comparing PG with PJ from Germany was published in 2015 (25).…”

Section: Pj Versus Pgmentioning

confidence: 99%

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

Kitahata¹,

Kawai²,

Yamaue³

2016

Transl. Gastroenterol. Hepatol.

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Pancreatic fistula is one of severe postoperative complications that occur after pancreatic surgery, such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). Because pancreatic fistula is associated with a higher incidence of life-threatening complications. In order to evaluate procedure or postoperative management to reduce pancreatic fistula after pancreatic surgery, we summarized some randomized controlled trials (RCTs) regarding pancreaticoenterostomy during PD, pancreatic duct stent during PD, procedure to resect pancreatic parenchyma during DP, and somatostatin and somatostatin analogues after pancreatic surgery.At first, we reviewed nine RCTs to compare pancreaticogastrostomy (PG) with pancreaticojejunostomy (PJ) during PD. Next, we reviewed five RCTs, to evaluate the impact of pancreatic duct stent during PD. Regarding DP, we reviewed six RCTs to evaluate appropriate procedure to reduce pancreatic fistula after DP. Finally, we reviewed eight RCTs to evaluate the impact of somatostatin and somatostatin analogues after pancreatic surgery to reduce pancreatic fistula. The best way to prevent pancreatic fistula after pancreatic surgery remains still controversial. However, several RCTs clarify a useful procedure to reduce in reducing the incidence of pancreatic fistula after pancreatic surgery. Further RCTs to study innovative approaches remain a high priority for pancreatic surgeons to prevent pancreatic fistula after pancreatic surgery.

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“…Alternative procedures include a binding or purse string suture around the anastomosis in the gastric wall [37] , with complete stitches traversing the anterior and posterior surface of the pancreatic stump associated with a ductto-mucosa anastomosis [38] or a "gastric partition" where the PG is performed [39] . An aspirating nasogastric tube is always recommended.…”

Section: Types Of Pancreatogastrostomiesmentioning

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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Pancreatogastrostomy With Gastric Partition After Pylorus-Preserving Pancreatoduodenectomy Versus Conventional Pancreatojejunostomy

Cited by 187 publications

References 40 publications

In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy

In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

Reconstruction after pancreatoduodenectomy: Pancreatojejunostomyvspancreatogastrostomy

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