The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta‐analysis of randomized controlled trials

Abstract

Reconstruction by PG decreases the rate of PF in comparison with PJ. Surgeons should consider reconstructing the pancreatic remnant following PD with PG, particularly in patients at high risk for PF.

Turkish Validation and Adaptation of Children ’s Chronotype Questionnaire (CCTQ)

“…It has been claimed that PG is a better pancreatic reconstruction method because it reduces the incidence and severity of POPF. Four recent meta-analyses based on eight randomized control trials have concluded that the POPF rate is significantly lower in PG than in PJ [28][29][30]. We recommended sutureless PG as an alternative to PJ because of the following advantages: (i) there is an absence of trans-pancreatic sutures because the trans-parenchymal sutures cause damage to the pancreatic tissues and leakage; (ii) PG is performed for a short time because of the proximity of the stomach to the pancreas; (iii) the stomach wall is well-vascularized and thick; (iv) there is early detection of intraluminal bleeding from the pancreatic remnant; (v) the pancreatic enzymes are inactive due to the high acidity in the stomach and a lack of enterokinase, which prevents a digestive damage to the PG; (vi) PG is isolated and is spaced apart from a. mesenterica superior, a. hepatica propria, v. portae and v. mesenterica superior; (vii) gastric decompression by a nasogastric tube eliminates gastric and pancreatic secretions, exerts less tension on PG, and can be used as a drainage if fistula occurs; and (viii) PG decreases the number of anastomoses in a single loop of jejunum, reducing the probability of loop kinking.…”

Minimally Invasive Surgery for Pancreatic Disease - Current Status

“…As far as reconstruction is concerned, pancreatogastrostomy and pancreaticojejunostomy seem to be equal to the open approach [50,51,52]. Nine recent meta-analyses showed a lower complication rate of pancreatogastrostomies compared to pancreaticojejunostomies regarding a reduced pancreatic fistula rate in open pancreatic surgery [53,54,55,56,57,58,59,60,61]. Pancreatogastrostomy offers the advantage of being more easily and quickly performed than pancreaticojejunostomy [62], which renders this reconstruction more feasible for the laparoscopic approach.…”

Enveloped double purse-string versus conventional pancreatico-gastrostomy during Whipple procedure: comparative study at Sohag university onco-surgery program

“…[13][14][15] However, more recent data provide clear evidence that PG is superior to PJ in terms of reduction of postoperative complication rates, principally the incidence of POPF. [16][17][18][19][20][21][22][23] In this study, we describe new EDPS technique for PG during Whipple procedure. Our approach entails insertion of the pancreatic remnant into the interior of the stomach via posterior gastrostomy.…”