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Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis

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Abstract

The definitive surgical management of periampullary tumors is a challenging endeavor. This article reviews the available data on the efficacy of various methods of pancreaticoenteric reconstruction designed for the prevention of pancreatic fistula (PF). A literature search of the Medline database was used to identify randomized controlled trials (RCTs) that compared pancreaticojejunostomy (PJ) with pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD). A total of two metaanalyses and four prospective RCTs were identified. Individual RCTs comparing PJ and PG allow the surgeons participating in the trial to choose technical modifications of one particular technique. As a result, there is no universal agreement as to whether one particular variation is safer and less prone to PF than the others. In addition, the majority of RCTs failed to stratify patient risk of PF. Further studies are therefore necessary to define the optimal technique of pancreatic reconstruction after PD conducted in high-volume centers by high-volume surgeons.

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Authors and Affiliations

  1. Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Laureano Fernández-Cruz, Enrique Jiménez Chavarria, Waldemar Adelsdorfer & Miguel Angel López-Boado

  2. Hospital Policlínico della Università degli studi di Napoli Federico II, Naples, Italy

    Andrea Belli & Joana Ferrer

  3. Hospital Universitario Austral, Buenos Aires, Argentina

    Mario Acosta

Authors
  1. Laureano Fernández-Cruz
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  2. Andrea Belli
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  3. Mario Acosta
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  4. Enrique Jiménez Chavarria
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  5. Waldemar Adelsdorfer
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  6. Miguel Angel López-Boado
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  7. Joana Ferrer
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Fernández-Cruz, L., Belli, A., Acosta, M. et al. Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis. Surg Today 41, 761–766 (2011). https://doi.org/10.1007/s00595-011-4515-1

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  • DOI: https://doi.org/10.1007/s00595-011-4515-1

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