Reconstruction methods after pancreaticoduodenectomy for pancreatic carcinoma: better method to prevent serious complications

Rashad, Hamed; Abd El-Mabood, El-Sayed A.; Elwan, Taher H.; Adbelmofeed, Ayman M.; Salama, Refaat S.; Gad, Emad H.

doi:10.4103/1110-1121.131662

Reconstruction methods after pancreaticoduodenectomy for pancreatic carcinoma: better method to prevent serious complications

Authors

Abstract

Purposes
The of aim of this study was to assess the safety of pancreatic anastomosis after pancreaticoduodenectomy (PD) and to compare the results of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) following PD in a prospective and randomized setting.
Background
Pancreatic fistula after PD represents a critical trigger of potentially life-threatening complications and is also associated with markedly prolonged hospitalization. The best method for dealing with the pancreatic stump after PD remains in question.
Patients and methods
The study included 50 patients, 33 (64%) men and 18 (36%) women with a mean age of 66.3 ± 4 years. All patients underwent clinical evaluation, laboratory assessment, and computed tomography or MRI examination. All patients undergoing PD with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). The postoperative follow-up ranged from 6 to 12 months.
Results
No mortality was recorded. The mean ICU stay duration was 2.4 ± 0.8 days. The duration of hospital and ICU stay was shorter in group PG ( = 0.03). The mortality because of surgical causes was higher in group PJ ( = 0.02). The frequency of postoperative complications - that is, pancreatic fistula ( = 0.0343), intra-abdominal bleeding and collection ( = 0.0376) - was higher in group PJ; however, there was no significance between both groups in the frequency of abdominal wall abscess and biliary leakage ( = 0.39). The patients with intra-abdominal collection were treated well by conservative measures in group PG ( = 0.023); however, patients who needed open drainage were less ( = 0.0376) and there was no significance between both groups in computed tomography-guided drainage ( = 0.56).
Conclusion
Pancreaticogastrostomy could be considered better as a reconstruction method; with shorter hospital stay, No Necrosis of pancreatic remnant, Less frequency of post operative complications & so Re-do with its complication is less.

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