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2015 ; 58
(3
): 154-9
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In search of the best reconstructive technique after pancreaticoduodenectomy:
pancreaticojejunostomy versus pancreaticogastrostomy
#MMPMID25799130
Grendar J
; Ouellet JF
; Sutherland FR
; Bathe OF
; Ball CG
; Dixon E
Can J Surg
2015[Jun]; 58
(3
): 154-9
PMID25799130
show ga
BACKGROUND: It has been suggested that pancreaticogastrostomy (PG) is a safer
reconstruction than pancreaticojejunostomy (PJ), resulting in lower morbidity,
including lower pancreatic leak rates and decreased postoperative mortality. We
compared PJ and PG after pancreaticoduodenectomy (PD). METHODS: A randomized
clinical trial was designed. It was stopped with 50% accrual. Patients underwent
either PG or PJ reconstruction. The primary outcome was the pancreatic fistula
rate, and the secondary outcomes were overall morbidity and mortality. We used
the Student t, Mann-Whitney U and ?(2) tests for intention to treat analysis. The
effect of randomization, American Society of Anesthesiologists score, soft
pancreatic texture and use of pancreatic stent on overall complications and
fistula rates was calculated using logistic regression. RESULTS: Our trial
included 98 patients. The rate of pancreatic fistula formation was 18% in the PJ
and 25% in the PG groups (p = 0.40). Postoperative complications occurred in 48%
of patients in the PJ and 58% in the PG groups (p = 0.31). There were no
significant predictors of overall complications in the multivariate analysis.
Only soft pancreatic gland predicted the occurrence of pancreatic fistula (odds
ratio 5.89, p = 0.003). CONCLUSION: There was no difference in the rates of
pancreatic leak/fistula, overall complications or mortality between patients
undergoing PG and and those undergoing PJ after PD.
|*Pancreaticoduodenectomy
[MESH]
|*Pancreaticojejunostomy
[MESH]
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Anastomosis, Surgical
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Intention to Treat Analysis
[MESH]
|Logistic Models
[MESH]
|Male
[MESH]
|Middle Aged
[MESH]
|Multivariate Analysis
[MESH]
|Pancreas/*surgery
[MESH]
|Pancreatic Fistula/epidemiology/etiology/*prevention & control
[MESH]
|Postoperative Complications/epidemiology/*prevention & control
[MESH]