Duct-to-mucosa versus invagination pancreaticogastrostomy reconstruction after pancreaticodudenectomy: a comparative study

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Abstract

Background
Pancreaticoduodenectomy (PD) is the most used standard operation for both benign and malignant diseases in the pancreatic head. Panc. Fistula following pancreaticoduodenectomy is relatively common and remains a major cause of mortality and morbidity.
Aim
To evaluate the early outcome of the main two techniques of pancreatic duct anastomosis with the stomach (duct-to mucosa vs. invagination) in patients who undergo pancreaticodudenectomy.
Patients and methods
This is a prospective randomized study was conducted on 50 patients with elective PD with two schedule techniques of pancreatic anastomoses with the stomach divided in two groups: group A (duct-to mucosa technique) and group B (invagination technique) performed in the department of the Hepato-pancreaticobiliary surgery, National Liver Institute, Menoufia University form October 2019 to October 2021.
Results
This study showed that, postoperative pancreatic fistula (POPF) developed in 1 (4%) case in group A and 5 (20%) cases in group B. regarding Delayed Gastric Empting (DGE), 15 (60.00%) patients had no DGE, 5 (20.00%) patients had grade A, 4 (16.00%) had grade B,1 (4.00%) had grade C among group A while, among group B, 20 (80.00%) patients had no DGE, 5 (20.00%) patients had grade A, with no significant difference ( = 0.126). Also, there was no statistically significant difference between the two groups regarding diagnostic tools, preoperative drainage as well tumor size, type of tumor regarding histopathological examination as the majority of examined specimens were adenocarcinoma.
Conclusion
Our study concluded that were Duct-to-mucosa pancreaticogastrostry is safer anastomosis. Following pancreatico duodenectomy other than invagination technique.

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