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Randomized Controlled Trial
. 2014 Aug;16(8):713-22.
doi: 10.1111/hpb.12210. Epub 2014 Jan 28.

Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study

Ayman El Nakeeb  1 , Emad Hamdy, Ahmad M Sultan, Tarek Salah, Waleed Askr, Helmy Ezzat, Mohamed Said, Mostaffa Abu Zeied, Tallat Abdallah
Affiliations
Randomized Controlled Trial

Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study

Ayman El Nakeeb et al. HPB (Oxford). 2014 Aug.

Abstract

Objectives: The optimal strategy for the reconstruction of the pancreas following pancreaticoduodenectomy (PD) is still debated. The aim of this study was to compare the outcomes of isolated Roux loop pancreaticojejunostomy (IRPJ) with those of pancreaticogastrostomy (PG) after PD.

Methods: Consecutive patients submitted to PD were randomized to either method of reconstruction. The primary outcome measure was the rate of postoperative pancreatic fistula (POPF). Secondary outcomes included operative time, day to resumption of oral feeding, postoperative morbidity and mortality, and exocrine and endocrine pancreatic functions.

Results: Ninety patients treated by PD were included in the study. The median total operative time was significantly longer in the IRPJ group (320 min versus 300 min; P = 0.047). Postoperative pancreatic fistula developed in nine of 45 patients in the IRPJ group and 10 of 45 patients in the PG group (P = 0.796). Seven IRPJ patients and four PG patients had POPF of type B or C (P = 0.710). Time to resumption of oral feeding was shorter in the IRPJ group (P = 0.03). Steatorrhea at 1 year was reported in nine of 42 IRPJ patients and 18 of 41 PG patients (P = 0.029). Albumin levels at 1 year were 3.6 g/dl in the IRPJ group and 3.3 g/dl in the PG group (P = 0.001).

Conclusions: Isolated Roux loop PJ was not associated with a lower rate of POPF, but was associated with a decrease in the incidence of postoperative steatorrhea. The technique allowed for early oral feeding and the maintenance of oral feeding even if POPF developed.

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Figures

Figure 1
Figure 1
Graphic representation of isolated Roux loop pancreaticojejunostomy (PJ) carried out using a 40-cm isolated loop of jejunum for PJ, and a Roux loop for hepaticojejunostomy (HJ) and gastrojejunostomy (GJ) (50 cm caudal to the HJ). The PJ loop was anastomosed to the main loop (20 cm caudal to the GJ)
Figure 2
Figure 2
Flow diagram showing progress through the phases of this randomized trial (i.e. enrolment, intervention allocation, follow-up and data analysis). PD, pancreaticoduodenectomy; PG, pancreaticogastrostomy; PJ, pancreaticojejunostomy
See this image and copyright information in PMC

References

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