2026-04-05T12:53:00Z https://www.peertechzpublications.org/oai-pmh

oai:www.peertechzpublications.org:10.17352/2455-2283.000048 2018-03-06 PTZ.ACG:VOL4

Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy to prevent post-operative pancreatic fi stula, a dissonance between evidence and practice Noman Shahzad Tabish Umer Chawla Saleema BegumFareed Ahmed Shaikh<p>Leakage of pancreatic enzymes leading to either formation of abdominal collection or pancreatic</p><p>fi stula is one the most feared complications after pancreaticoduodenectomy. Owing to high morbidity</p><p>and cost related to pancreatic fi stula, multiple interventions including various types of pancreaticoenteric</p><p>anastomosis have been proposed to prevent this complication. Despite some randomized</p><p>controlled trials and meta-analyses favoring pancreaticogastrostomy over pancreaticojejunostomy,</p><p>clinical practice has not witnessed any change in preference of individual surgeons. One of the underlying</p><p>facts is that there are various ways of doing pancreatic anastomosis and trials have compared only</p><p>specifi c techniques while a few novel techniques that have been reported to have very low pancreatic</p><p>fi stula risk have never been compared in randomized controlled trials comparing pancreaticogastrostomy</p><p>versus pancreaticojejunostomy. Moreover individual surgeons’ comfort and training also matters, and</p><p>in many instances same results are not reproduced as reported for primary center where technique</p><p>was developed. So though a good number of randomized controlled trials have been conducted to</p><p>compare pancreaticogastrostomy with pancreaticojejunostomy, variations in techniques of performing</p><p>anastomosis limit external validity as well as pooling the data for meta-analysis.</p><p>Furthermore subgroup of patients with soft pancreas, who are at high risk of pancreatic leak, should</p><p>be looked at separately for potential benefi t of type of pancreatic anastomosis.</p> Archives of Clinical Gastroenterology - Peertechz Publications 2018-03-06 Review Article https://doi.org/10.17352/2455-2283.000048 en Copyright © Noman Shahzad et al.