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Abstract

Pancreatico-Jejunostomy Decreases Postoperative Pancreatic Fistula Incidence and Severity after Central Pancreatectomy

Objectives Central pancreatectomy is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumors of pancreatic isthmus management. It is known for a high postoperative fistula rate. The purpose of this study was to compare postoperative pancreatic fistula incidence between pancreatico-jejunostomy and pancreatico-gastrostomy. Methods Fifty-eight patients (mean age 53.9±1.9 years) who underwent a central pancreatectomy in four French University Hospitals from 1988 to 2011 were analyzed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n=25) or to a Roux-en-Y jejunal loop (55.2%, n=35) with routine external drainage allowing a systematic search for postoperative pancreatic fistula. Postoperative pancreatic fistula severity was classified according ISGPF classification and Clavien-Dindo classification. Results The groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow up was 36.2±3.9 months. Postoperative pancreatic fistula were significantly more frequent after pancreatico-gastrostomy (76.9% vs. 37.5%, p=0.003). Pancreatico-gastrostomy was associated with significantly higher grade of postoperative pancreatic fistula both when graded with ISGPF classification (p=0.012) and Clavien-Dindo classification (p=0.044). There was no significant difference in postoperative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length stay was increased after pancreatico-gastrostomy (23.6±3.5 days vs. 16.5±1.9 days, p=0.071). There was no significant difference in incidence of long-term exocrine (3.8% vs. 19.2%, p=0.134) and endocrine (7.7% vs. 9.4%, p=0.575) pancreatic insufficiencies. Conclusions Pancreatico-gastrostomy was associated with a significantly higher POPF incidence and severity in central pancreatectomy. We recommend performing pancreatico-jejunostomy especially in older patients to improve central pancreatectomy outcomes.


Author(s):

Frédéric Borel, Mehdi Ouaissi, Aude Merdrignac, Aurelien Venara, Valéria De Franco, Laurent Sulpice, Antoine Hamy, Nicolas Regenet



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