Skip to main content

Abstract

Pancreaticoduodenectomy (PD) is the standard surgical treatment for resectable pancreatic head cancer. After resections, the reconstruction of the gastrointestinal continuity could be performed in different fashions. The aim of this review is to evaluate the different techniques of enteric reconstruction of pancreatic stump after PD: Invagination pancreaticojejunostomy, binding pancreaticojejunostomy, duct-to-mucosa pancreaticojejunostomy, Roux-en-Y pancreaticojejunostomy, and pancreaticogastrostomy. These gastric or enteric reconstructions are compared in terms of postoperative complications, postoperative pancreatic fistula, delayed gastric emptying, and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.

    Article  CAS  PubMed  Google Scholar 

  2. Whipple AO. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763–8. (abstract)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kausch W. Das Karzinoma der Papilla duodeni and seine radikale Entfernung. Betir Klin Chir. 1912;78:439–86. (abstract)

    Google Scholar 

  4. Gudjonsson B. Cancer of the pancreas. 50 years of surgery. Cancer. 1987;60:2284–303.

    Article  CAS  PubMed  Google Scholar 

  5. Gudjonsson B. Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting. J Am Coll Surg. 1995;181:483–503.

    CAS  PubMed  Google Scholar 

  6. Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’Graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000;87(7):883–9.

    Article  PubMed  Google Scholar 

  7. Schorn S, Demir IE, Vogel T, et al. Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy—a systematic review with meta-analysis. Langenbeck’s Arch Surg. 2019;404:141–57.

    Article  Google Scholar 

  8. Tan WJ, Kow AW, Liau KH. Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new. HPB (Oxford). 2011;13:566–72.

    Article  PubMed  Google Scholar 

  9. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.

    Article  PubMed  Google Scholar 

  10. Hunt VC. Surgical management of carcinoma of the ampulla of vater and of the periampullary portion of the duodenum. Ann Surg. 1941;114(4):570–602.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bassi C, Dervenis C, Butturini G, International Study Group on Pancreatic Fistula Definition, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.

    Article  PubMed  Google Scholar 

  12. Böttger TC, Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 resections. World J Surg. 1999;23(2):164–71. discussion 171–2

    Article  PubMed  Google Scholar 

  13. Cheng Q, Zhang B, Zhang Y, Jiang X, Zhang B, Yi B, Luo X, Wu M. Predictive factors for complications after pancreaticoduodenectomy. J Surg Res. 2007;139(1):22–9.

    Article  PubMed  Google Scholar 

  14. Peng SY, Wang JW, Li JT, Mou YP, Liu YB, Cai XJ. Pancreaticojejunostomy—a safe and reliable anastomosis procedure. HPB (Oxford). 2004;6(3):154–60.

    Article  CAS  PubMed  Google Scholar 

  15. Buc E, Flamein R, Golffier C, Dubois A, Nagarajan G, Futier E, et al. Peng’s binding pancreaticojejunostomy after pancreaticoduodenectomy: a French prospective study. J Gastrointest Surg. 2010;14:705–10.

    Article  PubMed  Google Scholar 

  16. Nordback I, Räty S, Laukkarinen J, Järvinen S, Piironen A, Leppiniemi J, et al. A novel radiopaque biodegradable stent for pancreatobiliary applications—the first human phase I trial in the pancreas. Pancreatology. 2012;12:264–71.

    Article  CAS  PubMed  Google Scholar 

  17. Hashimoto D, Hirota M, Yagi Y, H. Baba End-to-side pancreaticojejunostomy without stitches in the pancreatic stump. Surg Today. 2013;43(7):821–4.

    Article  PubMed  Google Scholar 

  18. Varco RL. A method of implanting the pancreatic duct into the jejunum in the Whipple operation for carcinoma of the pancreas: case report. Surgery. 1945;18:569–73.

    CAS  PubMed  Google Scholar 

  19. Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, Salvia R, Pederzoli P. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery. 2003;134(5):766–71.

    Article  PubMed  Google Scholar 

  20. Lee SE, Yang SH, Jang JY, Kim SW. Pancreatic fistula after pancreaticoduodenectomy: a comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: interrupted vs. continuous stitches. World J Gastroenterol. 2007;13(40):5351–6.

    Article  PubMed  PubMed Central  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  22. McKay A, Mackenzie S, Sutherland FR, et al. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. BJS. 2006;93(8):929–36.

    Article  CAS  Google Scholar 

  23. Martin RF, Zuberi KA. The evidence for technical considerations in pancreatic resections for malignancy. Surg Clin N Am. 2010;90(2):265–85.

    Article  PubMed  Google Scholar 

  24. He T, Zhao Y, Chen Q, Wang X, Lin H, Han W. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a systematic review and meta-analysis. Dig Surg. 2013;30(1):56–9.

    Article  PubMed  Google Scholar 

  25. Fabre JM, Arnaud JP, Navarro F, Bergamaschi R, Cervi C, Marrel E, Domergue J. Results of pancreatogastrostomy after pancreatoduodenectomy in 160 consecutive patients. Br J Surg. 1998;85(6):751–4.

    Article  CAS  PubMed  Google Scholar 

  26. Lemaire E, O’Toole D, Sauvanet A, Hammel P, Belghiti J, Ruszniewski P. Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis. Br J Surg. 2000;87(4):434–8.

    Article  CAS  PubMed  Google Scholar 

  27. Rault A, SaCunha A, Klopfenstein D, Larroudé D, Epoy FN, Collet D, Masson B. Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for long-term outcomes of pancreatic exocrine function. J Am Coll Surg. 2005;201(2):239–44.

    Article  PubMed  Google Scholar 

  28. Dubernard JM, Traeger J, Neyra P, Touraine JL, Blanc N, Devonec M. Long-term effect of néoprène injection in the canine pancreatic duct. Transplant Proc. 1979;11:1498–9.

    CAS  PubMed  Google Scholar 

  29. Suc B, Msika S, Fingerhut A, Fourtanier G, Hay JM, Holmières F, Sastre B, Fagniez PL. Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection: prospective randomized trial. Ann Surg. 2003;237:57–65.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Koti RS, Gurusamy KS, Fusai G, Davidson BR. Meta-analysis of randomized controlled trials on the effectiveness of somatostatin analogues for pancreatic surgery: a Cochrane review. HPB (Oxford). 2010;12:155–65.

    Article  PubMed  Google Scholar 

  31. Mimatsu K, Oida T, Kano H, Kawasaki A, Fukino N, Kida K, Kuboi Y, Amano S. Protection of major vessels and pancreaticogastrostomy using the falciform ligament and greater omentum for preventing pancreatic fistula in soft pancreatic texture after pancreaticoduodenectomy. Hepato-Gastroenterology. 2011;58:1782–6.

    PubMed  Google Scholar 

  32. Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg. 2007;246:425–33. discussion 433–435

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Juan Bellido-Luque .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bellido-Luque, J., Sanchez-Matamoros Martin, I., Gonzalez-Fernandez, D., Nogales Muñoz, A. (2023). Pancreatic Surgical Resections. In: Bellido Luque, J., Muñoz, A.N. (eds) Recent Innovations in Surgical Procedures of Pancreatic Neoplasms. Springer, Cham. https://doi.org/10.1007/978-3-031-21351-9_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-21351-9_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21350-2

  • Online ISBN: 978-3-031-21351-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics