To compare the outcomes of pancreaticojejunostomy and pancreaticogastrostomy reconstruction after pancreaticoduodenectomy: A prospective observational study.

Autor: Pandey AK; Department of GI Surgery, Army Hospital (R&R), Delhi, India., Sharma AK; Department of GI Surgery, Army Hospital (R&R), Delhi, India., Singh KJ; Department of GI Surgery, Command Hospital, Chandigargh, India., Kaistha S; Department of GI Surgery, Army Hospital (R&R), Delhi, India., Rakesh CR; Department of GI Surgery, Command Hospital (Air Force), Bengaluru, India., Karthik GSRS; Department of GI Surgery, Army Hospital (R&R), Delhi, India., Dash SC; Dean Academics & Deputy Commandant, Army Hospital (R&R), Delhi, India.
Jazyk: angličtina
Zdroj: Medical journal, Armed Forces India [Med J Armed Forces India] 2023 Jan; Vol. 79 (1), pp. 64-71. Date of Electronic Publication: 2021 Oct 08.
DOI: 10.1016/j.mjafi.2021.08.010
Abstrakt: Background: We have been in constant search of novel innovations to decrease the high morbidity after Pancreaticoduodenectomy (PD). Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the two different methods of reconstruction after PD. However, the existing data is ambiguous in supporting either of them as the preferred technique of reconstruction.
Methods: This was a single-center prospective observational study that included 64 patients who underwent PD over two years. We compared PG with PJ as a method of reconstruction after PD. The primary objective was to assess whether PG decreases the rate of postoperative pancreatic fistula (POPF) rates or not. Secondary objectives comprised analysis of perioperative outcomes, 30-day and 90-day mortality.
Results: Pancreatic fistula was significantly lower in PG as compared to the PJ group (24% vs. 47%) with a p-value of 0.027. The incidence of clinically pertinent (grade B) fistula was only 3% in the PG group and 32% in the PJ group. PG group had a higher incidence of post pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). No statistically significant difference was seen between either group need for blood transfusion, re-exploration, re-admissions, ICU stay, or length of hospital stay, and 30-day and 90-day mortality. Pancreatic texture and high BMI were independent predictors for pancreatic fistula.
Conclusion: PG when compared to PJ for reconstruction after PD, decreases the rate of POPF significantly; however, it is associated with an elevated risk of DGE and PPH. There was no difference in 30-day and 90-day mortality between both the treatment groups.
Competing Interests: The authors have none to declare.
(© 2021 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)
Databáze: MEDLINE
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