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Technical aspects of pancreatic anastomosis

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Summary

Background

Despite the significant improvement concerning perioperative mortality, pancreatoduodenectomy is still a challenging procedure. Pancreatic fistula is the most common complication underlying 30-day mortality. More than 61 surgical techniques of pancreatic anastomosis with a vast number of variations have been published. Moreover, various risk factors favoring the development of postoperative pancreatic fistulas have been identified.

Methods

This review article presents an outline of ways to achieve the optimal pancreatic anastomosis, concentrating on technical aspects. The following parameters were assessed in this question: pancreatojejunostomy, pancreaticogastrostomy, stents, tissue patches and sealants, surgical experience, and center-specific technique.

Results

With regard to current literature, there is no scientific evidence of an optimal pancreatic anastomotic technique. A distinct inhomogeneity among the trials concerning definitions, patient selection, anastomotic technique, and patient management is important to mention.

Conclusion

The best strategy for reducing pancreatic fistula rate includes a standardized institutional concept of pancreatic anastomosis, documentation of surgical quality, and continuous enhancement by benchmarking.

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Abbreviations

CI:

Confidence interval

CR-POPF:

Clinically relevant postoperative pancreatic fistula

FRS:

Fistula risk score

PG:

Pancreatogastrostomy

PJ:

Pancreatojejunostomy

POPF:

Postoperative pancreatic fistula

RCT:

Randomized controlled trail

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Authors and Affiliations

  1. Department of Surgery, Ordensklinikum Linz, Fadingerstraße 1, 4020, Linz, Austria

    Helwig Wundsam, Christiane S. Rösch, Ines Fischer & Reinhold Függer

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  1. Helwig Wundsam
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Correspondence to Reinhold Függer.

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H. Wundsam, C. S. Rösch, I. Fischer, and R. Függer declare that they have no competing interests.

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Wundsam, H., Rösch, C.S., Fischer, I. et al. Technical aspects of pancreatic anastomosis. Eur Surg 51, 90–97 (2019). https://doi.org/10.1007/s10353-019-0579-8

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