The Best Choice to Achieve Zero Complications after Pancreatoduodenectomy

Abstract

Pancreatoduodenectomy (PD) has been performed commonly, but the occurrence of pancreatic fistula (PF) is a critical trigger of complications, which are potentially life threatening, and is also associated with markedly prolonged hospitalization. Many techniques have been proposed for connecting the pancreatic stump with the gastrointestinal tract, stomach vs. jejunum, etc. Among the risk factors for PF, such as general patient factors or disease-related factors, the most important is the texture of the remnant pancreas. Surgical technique might be one improvable aspect that can reduce the pancreatic leakage rate, therefore; various methods of managing the pancreatic remnant have been studied. Methods of reconstruction between the remnant pancreas and the intestine include end-to-side with/without duct-to-mucosa anastomosis or end-to-end invagination styles, has been argued. Here, we review several trials for safety and methods of treating the pancreatic stump after PD, and demonstrate our experiences.

A Comparison of Two Invagination Techniques for Pancreatojejunostomy after Pancreatoduodenectomy

“…Anastomosis between the pancreatic end and the jejunum is performed as either end-to-side duct-to-mucosa anastomosis, end-to-side (dunking), or end-to-end invagination anastomosis [ 11 , 12 ]. It is difficult to speak of the superiority of the invagination technique over others, because the selection and use of an appropriate method depend on many factors.…”