Pancreaticogastrostomy as a choice of reconstruction after pancreaticoduodenectomy: a hospital based observational study

Authors

  • Hetish M. Reddy Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
  • Rajendra Bagree Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
  • Pradeep Panwar Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
  • Gaurav Jalendra Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20210373

Keywords:

Pancreatic fistula, Pancreaticogastrostomy, Pancreatojejunostomy, Pancreaticoduodenectomy, whipple’s procedure, Post-operative pancreatic fistula

Abstract

Background: The aim of this study was to compare the rate of occurrence of post-operative pancreatic fistulae (POPF) and other complications with pancreaticogastrostomy (PG) or pancreatojejunostomy (PJ) as a choice of reconstruction in classic Whipple’s Procedure.

Methods: A hospital based prospective observational study collected data of 60 patients who underwent Whipple’s procedure from June 2018 to august 2019, in two different surgical units, where one-unit preferred PG as routine while the other unit preferred PJ.

Results: Two out of 30 patients who underwent PG (Group A) developed POPF while Nine out of 30 patients who underwent PJ (Group B) developed POPF (p-value = 0.04) indicating a significant difference in outcome. The duration of hospital stay (DOHS) in our study in Group A was 12.82±1.74 days when compared to Group B was 13.88±2.01 days (p-value = 0.042).

Conclusions: Our results indicate that the preferred reconstruction after classic Pancreaticoduodenectomy should be Pancreaticogastrostomy, but further validation with randomized control trials or multicenter studies with larger sample size are required.

Author Biographies

Hetish M. Reddy, Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

department of general surgery

junior resident (post-graduate)

Rajendra Bagree, Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

department of general surgery

senior professor

Pradeep Panwar, Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

department of general surgery

junior resident (post-graduate)

Gaurav Jalendra, Department of General Surgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India

department of general surgery

junior resident (post-graduate)

References

Kawai M, Yamaue H. Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of 4pancreatic surgery. Surg Today. 2010;40:1011-7.

Bassi C, Butturini G, Molinari E. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg. 2004;21:54-9.

Schäfer M, Müllhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg. 2002;236:137-48.

Bassi C, Dervenis C, Butturini G. Postoperative pancreatic fistula: an International Study Group (ISGPF) definition. Surgery. 2005;138:8-13.

Topal B, Fieuws S, Aerts R, Weerts J, Feryn T. Pancreatico jejunostomy versus pancreatico gastrostomy reconstruction after pancreatico duodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2008;14(7):655-62.

Waugh JM, Clagett OT. Resection of the duodenum and head of the pancreas for carcinoma; an analysis of thirty cases. Surgery. 1946;20:224-32.

Crippa S, Cirocchi R, Randolph J. Pancreatico jejunostomy is comparable to pancreatico gastrostomy after pancreatico duodenectomy: an updated meta-analysis of randomized controlled trials. Langenbecks Arch Surg. 2016;401:427-37.

Wente MN, Shrikhande SV, Müller MW. Pancreatico jejunostomy versus pancreatico gastrostomy: systematic review and meta-analysis. Am J Surg. 2007;193:171-83.

Perivoliotis K, Sioka E, Tatsioni A. Pancreatogastrostomy versus pancreatojejunostomy: an Up-to-Date Meta-Analysis of RCTs. Int J Surg Oncol. 2017;2017:1-9.

Qin H, Luo L, Zhu Z. Pancreaticogastrostomy has advantages over pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy. A meta-analysis of randomized controlled trials. Int J Surg. 2016;36:18-24.

Zhang X, Ma L, Gao X. Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Surg Today. 2015;45:585-94.

Zhou Y, Yu J, Wu L. Meta-analysis of pancreatico gastrostomy versus pancreaticojejunostomy on occurrences of postoperative pancreatic fistula after pancreatico duodenectomy. Asian J Surg. 2015;38:155-60.

Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129-37.

Yeo CJ, Cameron JL, Maher MM. A prospective randomized trial of pancreatico gastrostomy versus pancreatico jejunostomy after pancreatico duodenectomy. Ann Surg. 1995;222:580-92.

Bassi C, Falconi M, Molinari E. Reconstruction by pancreatico jejunostomy versus pancreatico gastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005;242:767-73.

Duffas JP, Suc B, Msika S. A controlled randomized multicenter trial of pancreato gastrostomy or pancreato jejunostomy after pancreato duodenectomy. Am J Surg. 2005;189:720-9.

Fernandez-Cruz L, Cosa R, Blanco L, Lopez-Boado MA, Astudillo E. Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: a prospective randomized study. Ann Surg 2008;248:930-8.

Osada S, Imai H, Sasaki Y, Tanaka Y, Nonaka K, Yoshida K. Reconstruction method after pancreaticoduodenectomy. Idea to prevent serious complications. JOP. 2012;13:1-6.

Shen Y, Jin W. Reconstruction by pancreatico gastrostomy versus pancreatico jejunostomy following pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Gastroenterol Res Pract. 2012:7095.

Yang SH, Dou KF, Sharma N, Song WJ. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. World J Surg. 2011;35:2290-7.

Downloads

Published

2021-01-29

Issue

Section

Original Research Articles