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Archives of Clinical Gastroenterology

    Abstract

    Open Access Review Article PTZAID: ACG-4-148

    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.

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

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

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