Isolated Roux-en-Y loop for pancreatic and gastro-biliary anastomoses versus conventional single-loop jejunal reconstruction after pancreaticoduodenectomy: a randomized comparative study

Background
Pancreaticoduodenectomy (PD) is the definitive treatment in managing malignant and selected benign pancreatic and periampullary lesions. Pancreatico-enteric anastomosis is the ‘Achilles heel’ of reconstruction. Postoperative pancreatic fistula (POPF) paves the way for other complications and increases their severity. Anastomotic diversion into two isolated loops may contribute to decrease these problems.
Patients and methods
Fifty-two patients underwent PD for different pancreatic and periampullary lesions. The patients were divided randomly into two groups: 26 patients each. Isolated pancreatic anastomosis was done using Roux-en-Y loop reconstruction for pancreatic and gastro-biliary anastomoses were performed in one group, while conventional single jejunal loop was used for pancreatic, biliary, and gastric anastomoses. Preoperative, operative, and postoperative data were recorded and analyzed.
Results
There was no significant statistical difference between study groups in demographic data, comorbidities, clinical presentation, or type and site of pathologies. There was a significant difference favoring the isolated loop group as regards the hospital stay, time for drain removal, and major complication rates (=0.007, 0.020, and 0.035, respectively). POPF, biliary leakage, steatorrhea, postoperative hemorrhage, need for reoperation, delayed gastric emptying, intra-abdominal sepsis, time to resume oral fluids, and the postoperative mortality or morbidity within the first 30 postoperative days were reduced in the isolated loop group but the difference did not reach a statistical significance. While postoperative wound infection and pulmonary complications were less in the conventional groups but also the difference did not reach a statistically significant value.
Conclusion
Isolated Roux-en-Y loop pancreaticojejunostomy after PD is safe and easy. There was a reduction of POPF and biliary leak that did not reach a significant value, however, it decreased its related complications with significant reduction of hospital stay, time for drain removal, and major complication rates.