Surgery Today

, Volume 44, Issue 7, pp 1207–1213

Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy

  • Daisuke Hashimoto
  • Akira Chikamoto
  • Masaki Ohmuraya
  • Masahiko Hirota
  • Hideo Baba
Review Article

DOI: 10.1007/s00595-013-0662-x

Cite this article as:
Hashimoto, D., Chikamoto, A., Ohmuraya, M. et al. Surg Today (2014) 44: 1207. doi:10.1007/s00595-013-0662-x

Abstract

Over the past 100 years, advances in surgical techniques and perioperative management have reduced the morbidity and mortality after pancreaticoduodenectomy (PD). Many techniques have been proposed for the reconstruction of the pancreaticodigestive anastomosis to prevent the development of a postoperative pancreatic fistula (POPF), but which is the best approach is still highly debated. We carried out a systematic review to determine and compare the effectiveness of various methods of anastomosis after PD. A meta-analysis and most randomized controlled trials (RCTs) showed that the mortality, POPF rate and incidence of other postoperative complications were not statistically different between the pancreaticogastrostomy and pancreaticojejunostomy (PJ) groups. One RCT showed that a binding PJ significantly decreased the risk of POPF and other postoperative complications compared with conventional PJ. External duct stenting reduced the risk of clinically relevant POPF in a meta-analysis and RCTs. The prophylactic use of octreotide after PD does not result in a reduced incidence of POPF. In conclusion, our findings suggest that the successful management of pancreatic anastomoses may depend more on the meticulous surgical technique, surgical volume, and other management parameters than on the type of technique used. However, some new approaches, such as binding PJ, and the use of external stents should be considered in further RCTs.

Keywords

Pancreaticoduodenectomy Pancreaticogastrostomy Pancreaticojejunostomy Pancreatic fistula Complication 

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Daisuke Hashimoto
    • 1
  • Akira Chikamoto
    • 1
  • Masaki Ohmuraya
    • 2
  • Masahiko Hirota
    • 3
  • Hideo Baba
    • 1
  1. 1.Department of Gastroenterological SurgeryKumamoto University Graduate School of Medical SciencesKumamotoJapan
  2. 2.Institute of Resource Development and AnalysisKumamoto University Graduate School of Medical SciencesKumamotoJapan
  3. 3.Department of SurgeryKumamoto Regional Medical CenterKumamotoJapan

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