Isolated loop pancreaticojejunostomy vs. conventional pancreatic stump anastomosis following pancreaticoduodenectomy: anobservational study
Journal Title: INTERNATIONAL JOURNAL OF CURRENT RESEARCH - Year 2017, Vol 9, Issue 6
Abstract
Background: Surgical resection is the only potentially curative therapy for pancreatic and periampullary cancer. The morbidity and mortality of pancreaticoduodenectomy (PD) is related to the outcome of anastomosis. Methods: This was a retrospective analysis of prospectively collected datafrompatients undergoing PD for pancreatic or peri-ampullary cancers between 2010 and 2014.Whipple’s pancreaticoduodenectomy was performed by three expert, senior surgeons. Pancreatico-enteric anastomoses were either in the form of a pancreaticogastrostomy/pancreaticojejunostomy (PG/PJ; Group A), or isolated loop pancreaticojejunostomy (IPJ; Group B). The primary outcomes were pancreatic fistula formation, delayed gastric emptying, intra-abdominal abscess formation, post-pancreatectomy hemorrhage, and mortality. Operative variables such as duration of surgery, blood loss, and transfusion requirements were also assessed, and minor morbidities including pneumonitis, urinary tract infections, and wound infections were analyzed. Results: 140 patients underwent Whipple’s pancreaticoduodenectomy, 100 patients underwent PG/PJ (Group A) and 40 patients underwent IPJ (Group B). DGE was significantly less frequent in Group B compared to Group A patients, occurring in 10% and 33%, respectively (p=0.003). Pancreatic leak occurred in 31% of Group A patients and 15% of IPJ patients (Group B), with clinically significant grade B and C leaks occurring significantly less frequently in patients undergoing IPJ (13% in Group A vs. 0% in Group B, p=0.002). Intra-abdominal collections occurred in 14% of Group A patients compared to 12.5% of Group B patients. The mean postoperative hospital stay was 12.6 days in Group A and 11.2 in Group B patients. Post pancreatectomy hemorrhage was significantly higher in Group A (n=7) than in Group B (n=0). Conclusions: Isolated loop reconstruction has a significant influence on the frequency of delayed gastric emptying and the grade of leak. The overall leak rate was significantly different between groups, and clinically significant grade B and grade C leaks were significantly less frequent in patients receiving IPJ reconstructions. The IPJ technique also showed a trend toward lower mortality.
Authors and Affiliations
Prabhakaran Raju John Grifson John Rose, Chandrasekar Thiruvarur Sivaraman, Amudhan Anbalagan, Bennet Duraisamy and Kannan Devy Gounder
Keywords
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