Risk‐Adapted Anastomosis for Partial Pancreaticoduodenectomy Reduces the Risk of Pancreatic Fistula: A Pilot Study

Niedergethmann, Marco; Dusch, Niloufar; Widyaningsih, Rizky; Weiß, Christel; Kienle, Peter; Post, Stefan

doi:10.1007/s00268-010-0521-5

Cited by 28 publications

(34 citation statements)

References 53 publications

(68 reference statements)

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…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]. …”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the assignment of a given patient to PG or PJ was not randomized but at the surgeons' discretion in OCSs. The use of PG after PD has become increasingly popular, and more frequent in high-risk patients with a pancreatic duct ≤3 mm or a soft pancreas [49,56] (table 3). …”

Section: Discussionmentioning

confidence: 99%

“…The comparison of PF risk between PG and PJ alone may lead to some bias as PF of various severity varies in adverse effects on postoperative recovery, even a difference between life and death. PF severity was evaluated as recommended by ISGPF in only 1 RCT reported by Fernández-Cruz et al [10] and 3 OCSs [53,55,56] (table 3). An overall meta-analysis of PF after PG or PJ that required further medical or surgical intervention showed a statistically significant difference between the PG group and PJ group (p = 0.002).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

He¹,

Zhao

Chen³

et al. 2013

Dig Surg

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Background and Objectives: The method of pancreatic reconstruction after pancreaticoduodenectomy (PD) is closely associated with postoperative morbidity, mortality, and patient's quality of life. The objective of this study is to evaluate which anastomosis approach - pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is a better option of choice in terms of postoperative complications. Methods: Articles comparing PG and PJ that were published by July 2011 were retrieved and subjected to a systematic review and meta-analysis. Results: Four randomized controlled trials (RCTs) and 22 observational clinical studies (OCSs) were included. RCTs showed that the PG group had significantly lower incidence rates of postoperative intra-abdominal fluid collection (p = 0.003, relative risk (RR) 0.50, 95% CI 0.31-0.79) and multiple intra-abdominal complications (p = 0.0007, RR 0.26, 95% CI 0.12-0.56) than the PJ group. OCSs demonstrated significant differences between PG and PJ in terms of frequencies of postoperative biliary fistula, intra-abdominal fluid collection, pancreatic fistula, morbidity, and mortality. The overall analysis revealed significant differences in frequencies of intra-luminal hemorrhage (p = 0.03, OR 2.82, 95% CI 1.08-7.33) and grade B/C pancreatic fistula (p = 0.002, OR 0.42, 95% CI 0.24-0.73) between the two groups. Conclusions: Current literature has no adequate evidence to prove that PG is superior to PJ for patients undergoing PD in terms of postoperative complications. A standardized classification of pancreatic fistula and other intra-abdominal complications may enable an objective, valid comparison between PG and PJ.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

He¹,

Zhao

Chen³

et al. 2013

Dig Surg

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“…Long-term functional results are also a matter of concern with PG. Largely, PG is not favored, although a risk-adapted anastomotic choice has also been proposed [27]. …”

Section: Discussionmentioning

confidence: 99%

Blumgart’s Technique of Pancreaticojejunostomy: An Appraisal

Mishra

Saluja²,

Gupta³

et al. 2011

Dig Surg

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Background: Although mortality of Whipple’s pancreaticoduodenectomy (WPD) is reduced to <5%, morbidity still remains between 30 and 50%. Pancreaticojejunal anastomosis remains the main cause of morbidity. Blumgart anastomosis using transpancreatic U sutures has been proposed to decrease the leak rate and its associated morbidity. We analyzed the results of Blumgart anastomosis applied in consecutive cases of WPD. Methods: Of 189 patients with periampullary or pancreatic cancer admitted, 100 patients underwent WPD. Except for 2 patients (no duct identified preoperatively), all patients underwent pancreaticojejunostomy by the Blumgart anastomotic technique. The records of 98 patients were analyzed for pancreatic leak and its related complications using the definitions given by the International Study Group for Pancreatic Surgery. Results: Of 98 patients, 63 were men. The mean operative time was 390 min (270–690 min) and blood loss was 275 ml (100–1,000 ml). Overall mortality was 3.06%. The clinically significant pancreatic anastomotic failure leak was seen in only 7 (7.14%) cases (grade B, n = 4; grade C, n = 3) with one patient requiring relaparotomy due to leak. Only one patient died due to a leak-related complication. Conclusion: Blumgart pancreaticojejunal anastomosis can be routinely used for reconstruction in WPD. It is a technically simple procedure and is associated with low rates of fistula and its related complications.

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Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

Senda

Shimizu

Natsume

et al. 2017

British Journal of Surgery

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Background:The postoperative pancreatic fistula (POPF) rate for duct-to-mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct-to-mucosa versus invagination pancreaticojejunostomy.Methods: Patients were stratified by pancreatic texture and diameter of the main pancreatic duct and randomized to the duct-to-mucosa or invagination group. The primary endpoint was the rate of clinically relevant POPF (defined as grade B or C). Secondary endpoints were suture material cost for pancreaticojejunostomy, drain insertion duration and duration of postoperative hospital stay.Results: Some 120 patients undergoing pancreatoduodenectomy were included following consent. Clinically relevant POPF developed in six of 59 patients (10 per cent) in the invagination group and in 14 of 61 patients (23 per cent) in the duct-to-mucosa group (P = 0⋅077). Duration of drain insertion (6 versus 7 days respectively; P = 0⋅027) and postoperative hospital stay (19 versus 24 days; P = 0⋅015) were shorter in the invagination group. Subgroup analysis for 61 patients with a soft pancreas revealed a lower rate of clinically relevant POPF in the invagination group (10 per cent versus 42 per cent in the duct-to-mucosa group; P = 0⋅010). Among 20 patients with a clinically relevant POPF, the six patients in the invagination group had a shorter duration of drain insertion (38⋅5 days versus 49 days for 14 patients in the duct-to-mucosa group; P = 0⋅028) and postoperative hospital stay (42 versus 54⋅5 days respectively; P = 0⋅028). Conclusion:This study did not demonstrate a superiority of invagination over duct-to-mucosa pancreaticojejunostomy in the risk of POPF. However, in high-risk patients with a soft pancreas, invagination may reduce the risk of clinically relevant POPF compared with duct-to-mucosa. Registration number: UMIN000005890 (http://www.umin.ac.jp).

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Risk‐Adapted Anastomosis for Partial Pancreaticoduodenectomy Reduces the Risk of Pancreatic Fistula: A Pilot Study

Cited by 28 publications

References 53 publications

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

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

Blumgart’s Technique of Pancreaticojejunostomy: An Appraisal

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

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