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Single Versus Double Roux-en-Y Reconstruction Techniques in Pancreaticoduodenectomy: A Comparative Single-Center Study

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Abstract

Background

The aim of this study was to analyze the impact of single Roux-en-Y reconstruction (RYR) and double Roux-en-Y reconstruction (dRYR) on intraoperative outcome and postoperative morbidity and mortality after pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD).

Methods

All patients who underwent surgery between 2000 and 2005 for dRYR and RYR after PD or PPPD at the study hospital were evaluated for inclusion. Comparison of categorical patient characteristics was performed using the χ 2 test. Data were reported as median and range. Differences were analyzed with the Mann–Whitney U test. Postoperative complications were graded according to the Clavien-Dindo classification scheme and the recommendations of the International Study Group of Pancreatic Surgery (ISGPS).

Results

A total of 319 patients were included in final analysis. The median time of surgery was significantly shorter when performing a single Roux-en-Y loop reconstruction (55 min in PD and 50 min in PPPD) (p < 0.001). Saved time had a significant effect on the cost of surgery (p < 0.001). No impact on postoperative outcome according to the Clavien-Dindo classification, the ISGPS definitions of pancreatic fistulas, and delayed gastric emptying was evident. The relaparotomy rate due to severe postoperative hemorrhage was significantly higher in the dRYR PD cohort (2.2 vs. 11.9 %, p < 0.001).

Conclusions

Double Roux-en-Y reconstruction of the alimentary tract is not beneficial in terms of surgical outcome and postoperative morbidity and mortality and should be avoided due to unnecessarily prolonged surgery.

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Acknowledgments

The authors thank Önder Cantürk for the preparation of the illustrations.

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Faik G. Uzunoglu, Matthias Reeh, Romy Wollstein, Nathaniel Melling, Daniel Perez, Yogesh K. Vashist, Dean Bogoevski, Jakob R. Izbicki & Maximilian Bockhorn

Authors
  1. Faik G. Uzunoglu
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  2. Matthias Reeh
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  3. Romy Wollstein
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  4. Nathaniel Melling
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  5. Daniel Perez
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  6. Yogesh K. Vashist
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  7. Dean Bogoevski
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  8. Jakob R. Izbicki
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  9. Maximilian Bockhorn
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Corresponding author

Correspondence to Matthias Reeh.

Additional information

F. G. Uzunoglu and M. Reeh have contributed equally to this work.

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Uzunoglu, F.G., Reeh, M., Wollstein, R. et al. Single Versus Double Roux-en-Y Reconstruction Techniques in Pancreaticoduodenectomy: A Comparative Single-Center Study. World J Surg 38, 3228–3234 (2014). https://doi.org/10.1007/s00268-014-2742-5

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  • DOI: https://doi.org/10.1007/s00268-014-2742-5

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