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

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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.

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Conflict to interest

D. Hashimoto and co-authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Daisuke Hashimoto, Akira Chikamoto & Hideo Baba

  2. Institute of Resource Development and Analysis, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

    Masaki Ohmuraya

  3. Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan

    Masahiko Hirota

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  1. Daisuke Hashimoto
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  2. Akira Chikamoto
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  3. Masaki Ohmuraya
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  4. Masahiko Hirota
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  5. Hideo Baba
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Correspondence to Hideo Baba.

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Hashimoto, D., Chikamoto, A., Ohmuraya, M. et al. Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy. Surg Today 44, 1207–1213 (2014). https://doi.org/10.1007/s00595-013-0662-x

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