Reconstruction by Pancreaticojejunostomy Versus Pancreaticogastrostomy Following Pancreatectomy

Bassi, Claudio; Falconi, Massimo; Molinari, Enrico; Salvia, Roberto; Butturini, Giovanni; Sartori, Nora; Mantovani, William; Pederzoli, Paolo

doi:10.1097/01.sla.0000189124.47589.6d

Cited by 416 publications

(381 citation statements)

References 28 publications

Supporting

Mentioning

344

Contrasting

Unclassified

Order By: Relevance

“…A review of 160 patients by Fabre et al [17] showed an incidence of 22.5 % after PG reconstruction. A randomized study comparing pancreaticogastrostomy (PG) (69 patients) vs end-to-side pancreaticojejunostomy (PJ) (82 patients) showed that PG is superior regarding DGE rates (2 vs 10 patients or 3 vs 12 %, respectively, P =0.03) [20]. By using the PG reconstructive technique instead of PJ, the authors found that significantly less complications occur (25 vs 68 %, respectively, P =0.002).…”

Section: Discussionmentioning

confidence: 99%

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

et al. 2013

View full text Add to dashboard Cite

Although delayed gastric emptying (DGE) after Whipple's pancreaticoduodenectomy is not life-threatening and can be treated conservatively, it results in discomfort and significant prolongation of the hospital stay and adds on to the hospital costs. To overcome this problem, we started using the isolated loop technique of reconstruction along with pancreaticogastrostomy and we present our series using this technique. All consecutive patients undergoing Whipple's pancreaticoduodenectomy in a single surgical unit from January 2009 until December 2012 were included. In the absence of hepatic and peritoneal metastasis, resection (Whipple's procedure) with curative intent was done using isolated loop technique with pancreaticogastrostomy. Delayed gastric emptying was assessed clinically and on oral gastrograffin study. Bile reflux was also assessed on clinical parameters and evidence of beefy friable gastric mucosa on upper GI endoscopy and presence of reflux on hepatobiliary scintigraphy. A total of 52 patients were operated using this technique from January 2009 to October 2012. The mean operative time was 260.8±50.3, and the mean operative blood loss was 1,068.0±606.1 ml. Mean gastric emptying time 106.0±6.1 min (89-258 min). Three out of the 52(5.7 %) patients had persistent vomiting in the post-operative period requiring reinsertion of NG tube. A HIDA scan done on POD7 for all patients did not show any evidence of bile reflux in any of the patients. Pancreatogastrostomy with isolated loop in pancreaticoduodenal resection markedly reduces the post-operative incidence of alkaline reflux gastritis and DGE.

show abstract

Section: Discussionmentioning

confidence: 99%

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Until now, many authors compared the pancreatic leak [1][2][3] and the pancreatic exocrine and endocrine function between PG and PJ [4][5][6]. However, comparative analyses of pancreaticoenterostomy in many studies have been performed with various surgical methods.…”

Section: Introductionmentioning

confidence: 99%

Which Method Should We Select for Pancreatic Anastomosis After Pancreaticoduodenectomy?

et al. 2008

View full text Add to dashboard Cite

Background This study was designed to compare surgical, morphological, and functional outcomes of pancreaticoduodenectomy (PD) according to the types of pancreaticoenterostomy performed and to suggest a proper anastomotic method after PD. Methods From January 2001 to December 2006, 147 PDs were performed at Ajou University Medical Center. Surgical, morphological, functional, and nutritional outcomes after PD were retrospectively compared according to the types of management of pancreatic remnant and whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ), including duct-to-mucosa or invagination method, was performed. Results For the reconstruction method, 43 PG (30 ductto-mucosa and 13 invagination) and 100 PJ (33 duct-tomucosa and 67 invagination) were performed. Pancreatic leak rate in PG group (7%) was less than that in PJ group (13%); however, it was not significant (P [ 0.05). On the other hand, there was a significant difference in pancreatic leak between duct-to-mucosa and invagination (3.2 vs. 17.5%, P \ 0.05). Surprisingly, there was no pancreatic leak in PG duct-to-mucosa anastomosis after PD. There were no significant differences in the change of remnant pancreatic duct size, pancreatic thickness, presence of steatorrhea, and new-onset diabetes mellitus (DM) between PG and PJ. In the invagination group, the main pancreatic duct diameter was increased and pancreatic thickness was progressively reduced. Conclusion The duct-to-mucosa method is safer and has a good duct patency and low pancreas atrophy compared with the invagination method. In addition, PG duct-tomucosa is safer than PG invagination, but not in the PJ group. Therefore, we recommend PG duct-to-mucosa for reconstruction after PD because of safety and good duct patency, especially for inexperienced surgeons.

show abstract

“…Embora tenham sido descrito índices menores de fístula pancreática com a pancreaticogastrostomia, em três estudos prospectivos disponíveis na literatura, não foi encontrado diferença na comparação com a pancreaticojejunostomia 4,11,53 .…”

Section: Tratamento Do Coto Pancreáticounclassified

Diagnóstico, estadiamento e tratamento cirúrgico do adenocarcinoma de pâncreas

Amico¹,

Barreto²,

Dantas-Filho³

et al. 2008

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

Isso pode ser facilmente demonstrado pela estreita correlação entre o número de novos casos diagnosticados e a incidência de morte pela doença por ano nas várias regiões do mundo 1 . Felizmente no Brasil essa doença não figura entre as mais prevalentes causas de câncer, sendo responsável apenas por 4% das mortes por neoplasia maligna em nosso país 15 . A despeito disso os esforços se concentram para que a cura, possível em minoria dos pacientes, e a melhoria da qualidade de vida, naqueles com doença avançada localmente ou metastática, seja oferecida aos pacientes nos quais o diagnóstico de AP é feito.Admite-se que a única alternativa para a sua cura seja o tratamento cirúrgico. Ainda assim, apenas poucos pacientes submetidos à pancreatectomia sobrevivem mais que cinco anos. Mesmo naqueles pacientes com tumores pequenos, submetidos à ressecção com margens negativas e com gânglios livres de tumor a taxa de sobrevida em cinco anos alcança apenas 41% 5 . Para a maioria dos pacientes, no entanto, a cura não pode ser oferecida. Quando analisado a totalidade dos pacientes, apenas em 15-20% dos casos a ressecção é possível em virtude de doença avançada localmente ou pela presença de metástase à distância. Nesses casos é esperada sobrevida média de aproximadamente seis meses 33 .Em virtude dessa realidade, o cirurgião tem papel central na abordagem do AP sendo seus objetivos: 1) promover a ressecção cirúrgica com margens livres e 2) proporcionar um mínimo possível de morbidade e mortalidade com o tratamento. Acrescenta-se a isso a participação no processo decisório quanto à melhor paliação possível a ser aplicada aos pacientes que pode ser realizada de forma cirúrgica ou endoscópica.Frente à possibilidade do diagnóstico e tratamento alguns aspectos persistem controversos enquanto outros estão mais bem definidos. Esta revisão aborda o estado cialmente curativo. Na grande maioria dos pacientes o tumor é diagnosticado em fase avançada, comumente na presença de doença metastática. A introdução de modernos métodos diagnósticos associados ao aperfeiçoamento dos já existentes tem gerado controvérsia quanto à melhor maneira de se estabelecer o diagnóstico e estadiamento do tumor. Da mesma forma, o papel da cirurgia na paliação e aspectos técnicos da ressecção de lesões localizadas estão longe de alcançarem consenso na prática. Método -Revisão da literatura sobre os aspectos controversos relacionados ao tema e um algoritmo para a abordagem dos pacientes com suspeita de tumor de pâncreas são apresentados. Foram utilizados os descritores: "adenocarcinoma" e "pâncreas" para pesquisa no PubMed (www.pubmed.com) e na Bireme (www.bireme.br) e a seguir selecionadas as publicações pertinentes a cada tópico escolhido com atenção especial para metanálises, estudos clínicos controlados, revisões sitemáticas e ainda publicações de grandes centros especializados em doenças pancreáticas. Conclusões -Na suspeita de adenocarcinoma de pâncreas é possível realizar estadiamento muito próximo do real sem a necessidade da exploração cirúrgica sistemát...

show abstract

Reconstruction by Pancreaticojejunostomy Versus Pancreaticogastrostomy Following Pancreatectomy

Cited by 416 publications

References 28 publications

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

Preventing Delayed Gastric Emptying After Whipple's Procedure—Isolated Roux Loop Reconstruction With Pancreaticogastrostomy

Which Method Should We Select for Pancreatic Anastomosis After Pancreaticoduodenectomy?

Diagnóstico, estadiamento e tratamento cirúrgico do adenocarcinoma de pâncreas

Contact Info

Product

Resources

About