To compare the outcomes of pancreaticojejunostomy and pancreaticogastrostomy reconstruction after pancreaticoduodenectomy: A prospective observational study

Published on Oct 8, 2021in Medical journal, Armed Forces India
路 DOI :10.1016/J.MJAFI.2021.08.010
Alok Kumar Pandey , A. Sharma5
Estimated H-index: 5
+ 4 AuthorsSrikanta Dash34
Estimated H-index: 34
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Abstract
Abstract null null Background null We have been in constant search of novel innovations to decrease the high morbidity after Pancreaticoduodenectomy (PD). Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the two different methods of reconstruction after PD. However, the existing data is ambiguous in supporting either of them as the preferred technique of reconstruction. null null null Methods null This was a single-center prospective observational study that included 64 patients who underwent PD over two years. We compared PG with PJ as a method of reconstruction after PD. The primary objective was to assess whether PG decreases the rate of postoperative pancreatic fistula (POPF) rates or not. Secondary objectives comprised analysis of perioperative outcomes, 30-day and 90-day mortality. null null null Results null Pancreatic fistula was significantly lower in PG as compared to the PJ group (24% vs. 47%) with a p-value of 0.027. The incidence of clinically pertinent (grade B) fistula was only 3% in the PG group and 32% in the PJ group. PG group had a higher incidence of post pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). No statistically significant difference was seen between either group need for blood transfusion, re-exploration, re-admissions, ICU stay, or length of hospital stay, and 30-day and 90-day mortality. Pancreatic texture and high BMI were independent predictors for pancreatic fistula. null null null Conclusion null PG when compared to PJ for reconstruction after PD, decreases the rate of POPF significantly; however, it is associated with an elevated risk of DGE and PPH. There was no difference in 30-day and 90-day mortality between both the treatment groups.
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References27
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#1Asuri Krishna (AIIMS: All India Institute of Medical Sciences)H-Index: 9
#2Virinder Kumar Bansal (AIIMS: All India Institute of Medical Sciences)H-Index: 19
Last. Mahesh C. Misra (University of Medical Sciences and Technology)H-Index: 2
view all 6 authors...
Various modifications of the reconstruction following pancreaticoduodenectomy (PD) have been described. Pancreaticogastrostomy (PG) was first described clinically by Waugh and Clagett from the Mayo Clinic in 1946. Despite recent randomized trials and meta-analysis, the literature is still ambiguous as to which is a safer procedure. We hereby describe our experience of more than 400 pancreaticogastrostomies. The legacy of performing only pancreaticogastrostomy (PG) started by the senior author (B...
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#1S. Hayama (Hokkaido University)H-Index: 1
#2N. Senmaru (Hokkaido University)H-Index: 1
Last. Satoshi Hirano (Hokkaido University)H-Index: 60
view all 3 authors...
BACKGROUND: The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). METHODS: A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. ...
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#1Hua Qiu (NCU: Nanchang University)H-Index: 4
#2Renfeng Shan (NCU: Nanchang University)H-Index: 4
Last. Jun Shi (NCU: Nanchang University)H-Index: 5
view all 5 authors...
Objective: The purpose of this study was to investigate the rate and reasons and also the risk factors for unplanned reoperation after pancreatoduodenectomy (PD) in a single center. Patients and Methods: This retrospective analysis included patients who underwent PD in the First Affiliated Hospital of Nanchang University between January 2010 and January 2018. The patients were divided into nonreoperation and reoperation groups according to whether they underwent unplanned reoperation following t...
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: Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors...
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#1Yun Jin (ZJU: Zhejiang University)H-Index: 5
#2Yang-Yang Feng (ZJU: Zhejiang University)H-Index: 2
Last. Shu-You Peng (ZJU: Zhejiang University)H-Index: 13
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Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: An updated meta-analysis of RCTs and our experience
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Background: Periampullary neoplasms account for over 30,000 cancer-related deaths per year in the United States. Pancreaticoduodenectomy (PD) is considered the surgical standard and is the only curative treatment option for these pathologies. Objective: The objective of this study was to report the prognostic factors in survival and surgical complications in PD. Materials and Methods: A total of 178 cases are reported, several variables were reviewed and the same surgical technique was used by t...
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#1Sowmya Narayanan (UVA: University of Virginia)H-Index: 7
#2Allison N. Martin (UVA: University of Virginia)H-Index: 10
Last. Victor M. Zaydfudim (UVA: University of Virginia)H-Index: 24
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Abstract Background Safety of pancreaticoduodenectomy has improved significantly in the past 3聽decades. Current inpatient and 30-d mortality rates are low. However, incidence and causes of 90-d and 1-y mortality are poorly defined and largely unexplored. Methods All patients who had pancreaticoduodenectomy between 2007 and 2016 were included in this single institution, retrospective cohort study. Distributions of pancreaticoduodenectomy-specific morbidity and cause-specific mortality were compar...
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The goal of our study was to compare the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on the incidence of complications after pancreaticoduodenectomy. A systematic search was performed using RevMan 5.3 software. A meta-analysis showed that PG was not superior to PJ in ter
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#1Christopher B. Nahm (RNSH: Royal North Shore Hospital)H-Index: 9
#2Saxon Connor (Christchurch Hospital)H-Index: 34
Last. Anubhav Mittal (RNSH: Royal North Shore Hospital)H-Index: 24
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: Postoperative pancreatic fistula (POPF) remains the major cause of morbidity after pancreatic resection, affecting up to 41% of cases. With the recent development of a consensus definition of POPF, there has been a large number of reports examining various risk factors, prediction models, and mitigation strategies for this costly complication. Despite these strategies, the rates of POPF have not significantly diminished. Here, we review the literature and evidence regarding both traditional an...
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#1Katherine Giuliano (Johns Hopkins University)H-Index: 9
#2Aslam Ejaz (Johns Hopkins University)H-Index: 35
Last. Jin HeH-Index: 45
view all 3 authors...
Pancreatic cancer is the fourth leading cause of cancer-related death in the Unites States and is rising in incidence. For the 15鈥25% of patients who do not have either metastatic or locally advanced disease, surgical resection with pancreaticoduodenectomy is the standard of care and results in improved 5-year survival of 15鈥25%. While mortality at high-volume centers is less than 5%, morbidity remains high at approximately 30鈥45%. This paper reviews technical aspects of pancreaticoduodenectomy ...
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