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Review
. 2017 Nov 14:2:89.
doi: 10.21037/tgh.2017.11.02. eCollection 2017.

Different types of pancreatico-enteric anastomosis

Savio George Barreto  1   2 , Parul J Shukla  3
Affiliations
Review

Different types of pancreatico-enteric anastomosis

Savio George Barreto et al. Transl Gastroenterol Hepatol. .

Abstract

The pancreatico-enteric anastomosis has widely been regarded as the 'Achilles heel' of the modern day, single-stage, pancreatoduodenectomy (PD). A review of the literature was carried out to address the evolution of the pancreatico-enteric anastomosis following PD, the spectrum of anastomoses performed around the world, and finally present the current evidence in support of each anastomosis. Pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are the most common forms of pancreatico-enteric reconstruction following PD. There is no difference in postoperative pancreatic fistula (POPF) rates between PG and PJ, as well as individual variations, except in a high-risk anastomosis where performance of a PJ may be preferred. The routine use of glue, trans-anastomotic stents or omental wrapping is of no proven benefit. Externalised trans-anastomotic stents may have a role in mitigating the risk of a clinically relevant POPF in high-risk anastomoses. Pancreatico-enteric anastomosis is an important component of reconstruction following PD even though it is fraught with the risk of development of a POPF. Adherence to the tenets of anastomotic reconstruction and performance of a safe and reproducible anastomosis with a low clinically-relevant POPF rate remain the mainstay of achieving the best outcomes. Appropriate selection and opportune use of fistula mitigation strategies may help provide optimal outcomes when faced with the need to perform a high-risk pancreatico-enteric anastomosis.

Keywords: Pancreaticojejunostomy (PJ); pancreatic fistula; pancreaticogastrostomy (PG).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagrammatic representation of the invaginating end-to-side pancreaticojejunostomy.
Figure 2
Figure 2
Diagrammatic representation of the duct-to-mucosa pancreaticojejunostomy.
Figure 3
Figure 3
Diagrammatic representation of the end-to-end dunking/invaginating pancreaticojejunostomy.
Figure 4
Figure 4
Diagrammatic representation of the duct-to-mucosa pancreaticogastrostomy.
Figure 5
Figure 5
Diagrammatic representation of the invaginating end-to-side pancreaticogastrostomy.
See this image and copyright information in PMC

References

    1. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017;161:584-91. 10.1016/j.surg.2016.11.014 - DOI - PubMed
    1. Shukla PJ, Barreto SG, Fingerhut A. Do transanastomotic pancreatic ductal stents after pancreatic resections improve outcomes? Pancreas 2010;39:561-6. 10.1097/MPA.0b013e3181c52aab - DOI - PubMed
    1. Shukla PJ, Barreto SG, Fingerhut A, et al. Toward improving uniformity and standardization in the reporting of pancreatic anastomoses: a new classification system by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2010;147:144-53. 10.1016/j.surg.2009.09.003 - DOI - PubMed
    1. Shrikhande SV, Qureshi SS, Rajneesh N, et al. Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies? World J Surg 2005;29:1642-9. 10.1007/s00268-005-0137-3 - DOI - PubMed
    1. Kakita A, Yoshida M, Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique. J Hepatobiliary Pancreat Surg 2001;8:230-7. 10.1007/s005340170022 - DOI - PubMed