Reconstruction Following Pancreatectomy
Objective: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting.
Summary Background Data: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out.
Methods: A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ).
Results: The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P = not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P = 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P= not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P = 0.01), delayed gastric emptying (P = 0.03), and biliary fistula (P = 0.01). The mean postoperative hospitalization period stay was comparable in both groups.
Conclusions: When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications.
Treatment of the residual pancreatic cuff has always been a major problem in the reconstructive phase in pancreaticoduodenectomy (PD). Leakage and the consequent pancreatic fistula are the principal complications of PD and may be fatal. To prevent complications following PD, several pharmacologic prophylactic approaches as well as various surgical techniques have been proposed that range from single closure, use of rubber or fibrin glue to occlude the main duct, pancreaticoenterostomy with the jejunum or stomach (with or without external pancreatic duct drainage, using invaginating end-to-end or end-to-side, with one or 2-layer suture or duct-to-mucosa anastomosis), and even total pancreatectomy. With rare exceptions, there are almost no prospective, randomized trials comparing surgical techniques. In particular, only one randomized study has been published comparing pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ), while the remaining reports are either retrospective or uncontrolled studies.
The present manuscript reports the results from 151 patients having soft, residual pancreatic tissue and a small duct, who thus have a high risk of surgical complications, receiving either PG or PJ in a prospective, randomized fashion.
Objective: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting.
Summary Background Data: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out.
Methods: A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ).
Results: The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P = not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P = 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P= not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P = 0.01), delayed gastric emptying (P = 0.03), and biliary fistula (P = 0.01). The mean postoperative hospitalization period stay was comparable in both groups.
Conclusions: When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications.
Treatment of the residual pancreatic cuff has always been a major problem in the reconstructive phase in pancreaticoduodenectomy (PD). Leakage and the consequent pancreatic fistula are the principal complications of PD and may be fatal. To prevent complications following PD, several pharmacologic prophylactic approaches as well as various surgical techniques have been proposed that range from single closure, use of rubber or fibrin glue to occlude the main duct, pancreaticoenterostomy with the jejunum or stomach (with or without external pancreatic duct drainage, using invaginating end-to-end or end-to-side, with one or 2-layer suture or duct-to-mucosa anastomosis), and even total pancreatectomy. With rare exceptions, there are almost no prospective, randomized trials comparing surgical techniques. In particular, only one randomized study has been published comparing pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ), while the remaining reports are either retrospective or uncontrolled studies.
The present manuscript reports the results from 151 patients having soft, residual pancreatic tissue and a small duct, who thus have a high risk of surgical complications, receiving either PG or PJ in a prospective, randomized fashion.