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Type of Reconstruction After Pancreatoduodenectomy

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Pancreatic Cancer

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Abstract

Pancreatic anastomosis has always been the Achilles heel of pancreaticoduodenectomy (PD), and postoperative pancreatic fistula (POPF) is the leading cause of morbidity and mortality. Currently, there is no universally accepted standard technique for pancreatic reconstruction after PD. POPF after PD is still unsatisfactorily high, at 5–25%, even in high-volume centers. There are two major variants of pancreatic reconstruction after PD: pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). PG has been claimed to be a better pancreatic reconstruction in reducing the incidence and severity of POPF by most retrospective studies. However, not all of the published randomized controlled trials confirm the superiority of PG. In recent meta-analysis of published randomized controlled trials, PG has been shown to be associated with lower rate of POPF as compared with classic PJ. Blumgart PJ has been reported to decrease the POPF to 4.3–6.9%, significantly lower than the 10–20% of other techniques. Based on the matched historical control study at our institute, the modified Blumgart PJ appears to be superior to PG in reducing the incidence and severity of clinically relevant postoperative pancreatic fistula (CR-POPF). The modified Blumgart PJ can therefore be recommended as a fast, simple, and safe alternative for pancreatic reconstruction after PD.

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Authors and Affiliations

  1. Department of Surgery, Taipei Veterans General Hospital/National Yang Ming University, Taipei, Taiwan

    Yi-Ming Shyr & Shin-E Wang

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  1. Yi-Ming Shyr
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Correspondence to Yi-Ming Shyr .

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Editors and Affiliations

  1. Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea (Republic of)

    Sun-Whe Kim

  2. Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Hiroki Yamaue

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Shyr, YM., Wang, SE. (2017). Type of Reconstruction After Pancreatoduodenectomy. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_22

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  • DOI: https://doi.org/10.1007/978-3-662-47181-4_22

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