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

• Main Authors: Noman Shahzad (Author), Tabish Umer Chawla (Author), Saleema Begum (Author), Fareed Ahmed Shaikh (Author)
• Format: Book
• Published: Archives of Clinical Gastroenterology - Peertechz Publications, 2018-03-06.
• Subjects: Review Article
• Online Access: Connect to this object online.

<p>Leakage of pancreatic enzymes leading to either formation of abdominal collection or pancreatic</p><p>fi stula is one the most feared complications after pancreaticoduodenectomy. Owing to high morbidity</p><p>and cost related to pancreatic fi stula, multiple interventions including various types of pancreaticoenteric</p><p>anastomosis have been proposed to prevent this complication. Despite some randomized</p><p>controlled trials and meta-analyses favoring pancreaticogastrostomy over pancreaticojejunostomy,</p><p>clinical practice has not witnessed any change in preference of individual surgeons. One of the underlying</p><p>facts is that there are various ways of doing pancreatic anastomosis and trials have compared only</p><p>specifi c techniques while a few novel techniques that have been reported to have very low pancreatic</p><p>fi stula risk have never been compared in randomized controlled trials comparing pancreaticogastrostomy</p><p>versus pancreaticojejunostomy. Moreover individual surgeons' comfort and training also matters, and</p><p>in many instances same results are not reproduced as reported for primary center where technique</p><p>was developed. So though a good number of randomized controlled trials have been conducted to</p><p>compare pancreaticogastrostomy with pancreaticojejunostomy, variations in techniques of performing</p><p>anastomosis limit external validity as well as pooling the data for meta-analysis.</p><p>Furthermore subgroup of patients with soft pancreas, who are at high risk of pancreatic leak, should</p><p>be looked at separately for potential benefi t of type of pancreatic anastomosis.</p>