Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Sep 17;16(1):190.
doi: 10.1186/s12957-018-1491-6.

Comparison of clinical outcomes between mesh-reinforced pancreatojejunostomy and pancreatogastrostomy following pancreaticoduodenectomy: a cohort study

Junhai Pan  1 , Xiaolong Ge  1 , Wei Zhou  2 , Xin Zhong  1 , Lihu Gu  1 , Hepan Zhu  1 , Xinlong Li  1 , Weilin Qi  1 , Xianfa Wang  3
Affiliations
Comparative Study

Comparison of clinical outcomes between mesh-reinforced pancreatojejunostomy and pancreatogastrostomy following pancreaticoduodenectomy: a cohort study

Junhai Pan et al. World J Surg Oncol. .

Abstract

Background: Postoperative complications, especially postoperative pancreatic fistulas, remain the major concern following pancreaticoduodenectomy (PD). Mesh-reinforced pancreatic anastomoses, including pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), are a new effective technique in PD. This study was conducted to analyze the safety and efficacy of this new technique and to compare the results of mesh-reinforced PJ vs PG.

Methods: A total of 110 patients who underwent PD between August 2005 and January 2016 were eligible in this study. Perioperative and postoperative data of patients with a mesh-reinforced technique were analyzed. Data were also grouped according to the procedure performed: mesh-reinforced PJ and mesh-reinforced PG.

Results: Among patients undergoing PD with the mesh-reinforced technique, 42 had postoperative complications, and the comprehensive complication index (CCI) was 32.7 ± 2.5. Only 10% of patients had pancreatic fistula; three were grade A, six were grade B, and two were grade C. Biliary fistula occurred in only 8.2% of patients. Patients undergoing mesh-reinforced PG showed a significantly lower rate of CCI than did mesh-reinforced PJ patients (27.0 ± 2.1 vs 37.0 ± 3.9, p < 0.05). The mesh-reinforced PG was also favored over mesh-reinforced PJ because of significant differences in intra-abdominal fluid collection (5.9% vs 18.6%, p < 0.05) and delayed gastric emptying (3.9% vs 15.3%, p < 0.05).

Conclusions: PD with the mesh-reinforced technique was a safe and effective method of decreasing postoperative pancreatic fistula. Compared with mesh-reinforced PJ, mesh-reinforced PG did not show significant differences in the rates of pancreatic fistula or biliary fistula. However, CCI, intra-abdominal fluid collection, and delayed gastric emptying were significantly reduced in patients with mesh-reinforced PG.

Keywords: Mesh; Pancreatic fistula; Pancreaticoduodenectomy; Pancreatogastrostomy; Pancreatojejunostomy.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the ethics committee of Sir Run Run Shaw Hospital. Written informed consent was obtained from all participants.

Consent for publication

Written informed consent was obtained from all patients enrolled in the investigation. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and the guidelines of the regional ethical committees of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of vater. Ann Surg. 1935;102(4):763–779. doi: 10.1097/00000658-193510000-00023. - DOI - PMC - PubMed
    1. Senda Y, Shimizu Y, Natsume S, Ito S, Komori K, Abe T, et al. Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy. Br J Surg. 2018;105(1):48–57. doi: 10.1002/bjs.10727. - DOI - PubMed
    1. Bannone E, Andrianello S, Marchegiani G, Masini G, Malleo G, Bassi C, et al. Postoperative acute pancreatitis following pancreaticoduodenectomy: a determinant of fistula potentially driven by the intraoperative fluid management. Ann Surg. 2018. 10.1097/SLA.0000000000002900. - PubMed
    1. Wang WG, Babu SR, Wang L, Chen Y, Tian BL, He HB. Use of Clavien-Dindo classification in evaluating complications following pancreaticoduodenectomy in 1,056 cases: a retrospective analysis from one single institution. Oncol Lett. 2018;16(2):2023–2029. - PMC - PubMed
    1. Kunstman JW, Starker LF, Healy JM, Salem RR. Pancreaticoduodenectomy can be performed safely with rare employment of surgical drains. Am Surg. 2017;83(3):265–273. - PubMed

Publication types

LinkOut - more resources