Shailesh V Shrikhande1, George Barreto, Parul J Shukla. 1. Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai 400 012, India. shailushrikhande@hotmail.com
Abstract
BACKGROUND: The leading cause for morbidity and mortality after pancreaticoduodenectomy is a pancreatic anastomotic leak and fistula. The two most commonly performed anastomoses after pancreaticoduodenectomy are pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ). The role of standardization on outcomes after pancreaticoduodenectomy has not been sufficiently addressed. AIM: The goal is to study the impact of a standardized technique of pancreatic anastomosis (PJ) after pancreaticoduodenectomy in a tertiary referral cancer teaching hospital. MATERIALS AND METHODS: A single-institution database was analyzed over 15 years. The entire data were subdivided into two periods, viz., period A (1992 to 2001), when PG (dunking) was predominantly used, and period B (2003-2007), when a standardized technique of PJ (duct to mucosa) was employed. RESULTS: There were 144 pancreaticoduodenectomies performed during period A with a pancreatic fistula rate of 16%. During period B, 123 pancreaticoduodenectomies were performed with a pancreatic fistula rate of 3.2% (p < 0.0005). CONCLUSIONS: It appears that a standardized approach to the pancreatic anastomosis and a consistent practice of a single technique can help to reduce the incidence of complications after pancreaticoduodenectomy.
BACKGROUND: The leading cause for morbidity and mortality after pancreaticoduodenectomy is a pancreatic anastomotic leak and fistula. The two most commonly performed anastomoses after pancreaticoduodenectomy are pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ). The role of standardization on outcomes after pancreaticoduodenectomy has not been sufficiently addressed. AIM: The goal is to study the impact of a standardized technique of pancreatic anastomosis (PJ) after pancreaticoduodenectomy in a tertiary referral cancer teaching hospital. MATERIALS AND METHODS: A single-institution database was analyzed over 15 years. The entire data were subdivided into two periods, viz., period A (1992 to 2001), when PG (dunking) was predominantly used, and period B (2003-2007), when a standardized technique of PJ (duct to mucosa) was employed. RESULTS: There were 144 pancreaticoduodenectomies performed during period A with a pancreatic fistula rate of 16%. During period B, 123 pancreaticoduodenectomies were performed with a pancreatic fistula rate of 3.2% (p < 0.0005). CONCLUSIONS: It appears that a standardized approach to the pancreatic anastomosis and a consistent practice of a single technique can help to reduce the incidence of complications after pancreaticoduodenectomy.
Authors: Moritz N Wente; Shailesh V Shrikhande; Michael W Müller; Markus K Diener; Christoph M Seiler; Helmut Friess; Markus W Büchler Journal: Am J Surg Date: 2007-02 Impact factor: 2.565
Authors: C J Yeo; J L Cameron; M M Maher; P K Sauter; M L Zahurak; M A Talamini; K D Lillemoe; H A Pitt Journal: Ann Surg Date: 1995-10 Impact factor: 12.969
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