To reduce the occurrence of pancreatic fistula, various techniques have been described such as duct ligation, pancreatogastrostomy
, and others, but none has been widely adopted.
In case of a pancreatoenteral anastomosis, either a pancreatojejunostomy or a pancreatogastrostomy
Arvanitakis et al., "EUS-guided pancreatogastrostomy
and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy," Gastrointestinal Endoscopy, vol.
Pancreatogastrostomy: a safe drainage procedure after pancreatoduodenectomy.
Pancreatogastrostomy: an ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis.
The two most widely adopted postpancreaticoduodenectomy anastomotic techniques are the pancreatogastrostomy (PG) and the pancreatojejunostomy (PJ), which combined with anastomotic reinforcing techniques, such as glue and intraductal stenting, are designed to provide a sealed and stable pancreatoenteric junction.
(i) MEDLINE: (Pancreaticoduodenectomy OR Pancreatoduodenectomy OR Whipple OR "pancreatoduodenal resection" OR "pancreaticoduodenal resection" OR pancreaticojejunostomy OR pancreatojejunostomy OR "pancreaticoenteric anastomosis" OR "pancreatoenteric anastomosis" OR pancreaticogastrostomy OR pancreatogastrostomy OR "pancreaticogastric anastomosis" OR "pancreatogastric anastomosis" OR "pancreaticojejunal anastomosis" OR "pancreatojejunal anastomosis") AND ("Clinical Trials as Topic" OR "randomized controlled trial" OR "controlled clinical trial" OR randomized OR placebo OR randomly OR trial)
Completion anastomoses were by means of end-to-side, duct-to-mucosa pancreaticojejunostomy (PJ) or pancreatogastrostomy
(PG), end-to-side hepaticojejunostomy (HJ) and duodenojejunostomy (DJ) or gastrojejunostomy (GJ).
decreased re laprotomycaused by pancreatic fistulaafter pancreatoduodenectomy compared with pancreatojejonostomy Arch Surg 2004; 139: 327-335.
Keck, "Reduced postoperative pancreatic fistula rate after pancreatogastrostomy
versus pancreaticojejunostomy," Journal of Gastrointestinal Surgery, vol.
has also been used in this situation, with minimal morbidity.
The remaining 5 patients (4.9%) underwent a pylorus-preserving pancreaticoduodenectomy; 3 of the 5 had a pancreatojejunal anastomosis, but in 2 patients gross oedema of the jejunum precluded a safe pancreatic anastomosis and both had a pancreatogastrostomy
. All 5 patients developed postoperative complications, which included a bile leak, pancreatic fistula, jejunal fistula, renal failure, subphrenic abscess and wound sepsis.