Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy to prevent post-operative pancreatic fi stula, a dissonance between evidence and practice

Noman Shahzad*, Tabish Umer Chawla, Saleema Begum and Fareed Ahmed Shaikh

Leakage of pancreatic enzymes leading to either formation of abdominal collection or pancreatic

fi stula is one the most feared complications after pancreaticoduodenectomy. Owing to high morbidity

and cost related to pancreatic fi stula, multiple interventions including various types of pancreaticoenteric

anastomosis have been proposed to prevent this complication. Despite some randomized

controlled trials and meta-analyses favoring pancreaticogastrostomy over pancreaticojejunostomy,

clinical practice has not witnessed any change in preference of individual surgeons. One of the underlying

facts is that there are various ways of doing pancreatic anastomosis and trials have compared only

specifi c techniques while a few novel techniques that have been reported to have very low pancreatic

fi stula risk have never been compared in randomized controlled trials comparing pancreaticogastrostomy

versus pancreaticojejunostomy. Moreover individual surgeons’ comfort and training also matters, and

in many instances same results are not reproduced as reported for primary center where technique

was developed. So though a good number of randomized controlled trials have been conducted to

compare pancreaticogastrostomy with pancreaticojejunostomy, variations in techniques of performing

anastomosis limit external validity as well as pooling the data for meta-analysis.

Furthermore subgroup of patients with soft pancreas, who are at high risk of pancreatic leak, should

be looked at separately for potential benefi t of type of pancreatic anastomosis.

Keywords:

Published on: Mar 6, 2018 Pages: 8-11

Full Text PDF Full Text HTML DOI: 10.17352/2455-2283.000048
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