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Journal of Gastrointestinal Surgery

, Volume 22, Issue 1, pp 68–76 | Cite as

Pancreatogastrostomy Vs. Pancreatojejunostomy: a Risk-Stratified Analysis of 5316 Pancreatoduodenectomies

  • Brett L. Ecker
  • Matthew T. McMillan
  • Laura Maggino
  • Valentina Allegrini
  • Horacio J. Asbun
  • Chad G. Ball
  • Claudio Bassi
  • Joal D. Beane
  • Stephen W. Behrman
  • Adam C. Berger
  • Mark Bloomston
  • Mark P. Callery
  • John D. Christein
  • Euan Dickson
  • Elijah Dixon
  • Jeffrey A. Drebin
  • Carlos Fernandez-Del Castillo
  • William E. Fisher
  • Zhi Ven Fong
  • Ericka Haverick
  • Robert H. Hollis
  • Michael G. House
  • Steven J. Hughes
  • Nigel B. Jamieson
  • Tara S. Kent
  • Stacy J. Kowalsky
  • John W. Kunstman
  • Giuseppe Malleo
  • Ronald R. Salem
  • Kevin C. Soares
  • Vicente ValeroIII
  • Ammara A. Watkins
  • Christopher L. Wolfgang
  • Amer H. Zureikat
  • Charles M. VollmerJr
2017 SSAT Plenary Presentation

Introduction

Clinically relevant pancreatic fistula (CR-POPF) is a major cause of procedural morbidity following pancreatoduodenectomy (PD), and accounts for over one-third of mortalities.1,2 Despite advances in surgical technique and improved rates of perioperative mortality,3 CR-POPF continues to occur in approximately 11% of patients.4

It has been postulated that one potential mitigation strategy to reduce the occurrence of CR-POPF is the use of pancreatogastrostomy (PG) reconstruction. As compared to pancreatojejunostomy (PJ), the anastomosis between the pancreatic remnant and the stomach provides several putative advantages: (1) technical ease (thick gastric wall; proximity of the pancreatic remnant to the posterior gastric wall); (2) robust gastric blood supply; and (3) lack of enterokinase to prevent activation of pancreatic enzymes. At least five randomized controlled trials (RCTs) have assessed the value of PG in the contemporary era, using the consensus definition of CR-POPF,

Keywords

Pancreatogastrostomy Pancreatojejunostomy Pancreatic fistula Pancreatoduodenectomy Severity weighting Postoperative morbidity index Risk stratification 

Abbreviations

ACB

Average Complication Burden

CR-POPF

clinically relevant postoperative pancreatic fistula

FRS

Fistula Risk Score

ISGPF

International Study Group on Pancreatic Fistula

IQR

interquartile range

OR

odds ratio

PD

pancreatoduodenectomy

PMI

Postoperative Morbidity Index

POPF

postoperative pancreatic fistula

RCT

randomized controlled trial

Notes

Author Contributions

conception/design (BL Ecker, MT McMillan, L Maggino, CM Vollmer); data acquisition (BL Ecker, MT McMillan, JD Beane, ZV Fong, E Haverick); data interpretation (all authors); drafting (BL Ecker, CM Vollmer); critical revisions (all authors); final approval (all authors)

Funding

None

Compliance with Ethical Standards

Meeting Presentations

Presented at (1) the SSAT Residents and Fellows Research Conference, May 6, 2017, Chicago, IL; and (2) the 2017 SSAT Presidential Plenary Presentation, May 7, 2017, Chicago, IL

Supplementary material

11605_2017_3547_MOESM1_ESM.docx (12 kb)
ESM 1 (DOCX 12 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Brett L. Ecker
    • 1
  • Matthew T. McMillan
    • 1
  • Laura Maggino
    • 1
    • 2
  • Valentina Allegrini
    • 2
  • Horacio J. Asbun
    • 3
  • Chad G. Ball
    • 4
  • Claudio Bassi
    • 2
  • Joal D. Beane
    • 5
  • Stephen W. Behrman
    • 6
  • Adam C. Berger
    • 7
  • Mark Bloomston
    • 8
  • Mark P. Callery
    • 9
  • John D. Christein
    • 10
  • Euan Dickson
    • 11
  • Elijah Dixon
    • 4
  • Jeffrey A. Drebin
    • 1
  • Carlos Fernandez-Del Castillo
    • 12
  • William E. Fisher
    • 13
  • Zhi Ven Fong
    • 12
  • Ericka Haverick
    • 8
  • Robert H. Hollis
    • 10
  • Michael G. House
    • 5
  • Steven J. Hughes
    • 14
  • Nigel B. Jamieson
    • 11
  • Tara S. Kent
    • 9
  • Stacy J. Kowalsky
    • 15
  • John W. Kunstman
    • 16
  • Giuseppe Malleo
    • 2
  • Ronald R. Salem
    • 16
  • Kevin C. Soares
    • 17
  • Vicente ValeroIII
    • 17
  • Ammara A. Watkins
    • 9
  • Christopher L. Wolfgang
    • 17
  • Amer H. Zureikat
    • 15
  • Charles M. VollmerJr
    • 1
  1. 1.Departments of SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  2. 2.Departments of SurgeryUniversity of VeronaVeronaItaly
  3. 3.Departments of Surgery, Mayo ClinicJacksonvilleUSA
  4. 4.Departments of SurgeryUniversity of CalgaryAlbertaUSA
  5. 5.Departments of SurgeryIndiana University School of MedicineIndianapolisUSA
  6. 6.Departments of SurgeryUniversity of Tennessee Health Science CenterMemphisUSA
  7. 7.Departments of Surgery, Jefferson Medical CollegePhiladelphiaUSA
  8. 8.Departments of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  9. 9.Departments of SurgeryBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  10. 10.Departments of SurgeryUniversity of Alabama School of MedicineBirminghamUSA
  11. 11.Departments of SurgeryUniversity of GlasgowGlasgowUK
  12. 12.Departments of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  13. 13.Departments of SurgeryBaylor College of MedicineHoustonUSA
  14. 14.Departments of SurgeryUniversity of Florida College of MedicineGainesvilleUSA
  15. 15.Departments of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  16. 16.Departments of SurgeryYale School of MedicineNew HavenUSA
  17. 17.Departments of SurgeryJohns Hopkins School of MedicineBaltimoreUSA

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