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Journal of Gastrointestinal Surgery

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01-04-2009 | original article

Reduced Postoperative Pancreatic Fistula Rate After Pancreatogastrostomy Versus Pancreaticojejunostomy

Authors: U. Wellner, F. Makowiec, E. Fischer, U. T. Hopt, T. Keck

Published in: Journal of Gastrointestinal Surgery | Issue 4/2009

Abstract

Introduction

Metaanalysis of retrospective studies employing various definitions of pancreatic fistulas demonstrated a reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy. Prospective trials failed to do so, which causes an ongoing debate on the superiority of one or the other procedure. The aim of this study was to compare the two types of anastomosis at our institution with regard to postoperative pancreatic fistula and other complications.

Materials and Methods

From 2001 to 2007, 114 pancreatogastrostomies and 115 pancreaticojejunostomies were performed. For retrospective analysis, the ISGPS definitions were employed. Primary endpoint was the occurrence of postoperative pancreatic fistula grade B or C. Secondary endpoints were postpancreatectomy hemorrhage, delayed gastric emptying, intraabdominal fluid collection, reoperation, and mortality. Operative time, intensive care unit stay, and overall hospital stay were also compared.

Results

With pancreatogastrostomy, there were significantly less postoperative pancreatic fistulae grade B and C (pancreatogastrostomy (PG) versus pancreaticojejunostomy (PJ), 11.4% versus 22.6%, p = 0.03), more intraluminal hemorrhage (PG versus PJ, 10.5% versus 0%, p < 0.001) and more delayed gastric emptying grade B and C (PG versus PJ, 18.3% versus 7.9%, p = 0.03). Operative time was shorter (PG versus PJ, median 420 versus 450 min, p < 0.01), and intensive care unit stay was longer (PG versus PJ, median 4 days versus 5 days, p < 0.01), with a tendency toward reduced overall hospital stay (PG versus PJ, median 17 versus 19 days, p = 0.08).

Conclusion

Surgeons should be aware of a higher rate of delayed gastric emptying and perform meticulous hemostasis to prevent intraluminal bleeding with pancreatogastrostomy. Pancreatogastrostomy is superior to pancreaticojejunostomy in terms of relevant postoperative pancreatic fistula.

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Title: Reduced Postoperative Pancreatic Fistula Rate After Pancreatogastrostomy Versus Pancreaticojejunostomy
Authors: U. Wellner
F. Makowiec
E. Fischer
U. T. Hopt
T. Keck
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 4/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0763-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reduced Postoperative Pancreatic Fistula Rate After Pancreatogastrostomy Versus Pancreaticojejunostomy

Abstract

Introduction

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and Methods

Results

Conclusion

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