OBJECTIVE: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting. SUMMARY BACKGROUND DATA: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out. METHODS: A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). RESULTS: The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P = not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P = 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P = not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P = 0.01), delayed gastric emptying (P = 0.03), and biliary fistula (P = 0.01). The mean postoperative hospitalization period stay was comparable in both groups. CONCLUSIONS: When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications.
RCT Entities:
OBJECTIVE: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting. SUMMARY BACKGROUND DATA: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out. METHODS: A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). RESULTS: The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P = not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P = 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P = not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P = 0.01), delayed gastric emptying (P = 0.03), and biliary fistula (P = 0.01). The mean postoperative hospitalization period stay was comparable in both groups. CONCLUSIONS: When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: C J Yeo; J L Cameron; K D Lillemoe; P K Sauter; J Coleman; T A Sohn; K A Campbell; M A Choti Journal: Ann Surg Date: 2000-09 Impact factor: 12.969
Authors: Steven M Strasberg; Jeffrey A Drebin; Nahush A Mokadam; Douglas W Green; Karen L Jones; Justis P Ehlers; David Linehan Journal: J Am Coll Surg Date: 2002-06 Impact factor: 6.113
Authors: Parul J Shukla; Savio G Barreto; Mms Bedi; N Bheerappa; Adarsh Chaudhary; Md Gandhi; M Jacob; S Jesvanth; Dg Kannan; Vinay K Kapoor; A Kumar; Kk Maudar; Hariharan Ramesh; Ra Sastry; Rajan Saxena; Ajit Sewkani; S Sharma; Shailesh V Shrikhande; A Singh; Rajneesh K Singh; R Surendran; Subodh Varshney; V Verma; V Vimalraj Journal: HPB (Oxford) Date: 2009-12 Impact factor: 3.647
Authors: Ronnie T P Poon; Sheung Tat Fan; Chung Mau Lo; Kelvin K Ng; Wai Key Yuen; Chun Yeung; John Wong Journal: Ann Surg Date: 2007-09 Impact factor: 12.969
Authors: Kaye M Reid-Lombardo; Michael B Farnell; Stefano Crippa; Matthew Barnett; George Maupin; Claudio Bassi; L William Traverso Journal: J Gastrointest Surg Date: 2007-08-21 Impact factor: 3.452
Authors: Gerard J Abood; M Fatih Can; Mustapha Daouadi; Harold T Huss; Jennifer Y Steve; Lekshmi Ramalingam; Michael Stang; David L Bartlett; Herbert J Zeh; A James Moser Journal: J Gastrointest Surg Date: 2013-01-17 Impact factor: 3.452