Do transanastomotic pancreatic ductal stents after pancreatic resections improve outcomes?
OBJECTIVE
Despite strategies aimed at reducing a postoperative pancreatic fistula (POPF) after pancreatectomies, the overall incidence remains unchanged. One such procedure, until now incompletely explored, is transanastomotic pancreatic (TAP) ductal stenting.


METHODS
We conducted a systematic search using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1983-2008 to determine if TAP ductal stents provide any benefit and, if so, in which clinical scenarios they can be recommended.


RESULTS
Stents can be internal or external, intraoperative only, or temporary (several days). One randomized trial on internal stents across pancreaticojejunostomy (PJ) suggested a higher POPF rate in the stented group. One nonrandomized study using an internal stent for pancreaticogastrostomy (PG) revealed a 0% POPF rate. Results from studies where external stents were used across PJ/PG reported a lower incidence of POPF. No statistically significant difference was reported in a POPF incidence when internal stents were compared with externalized stents. Available data suggest improved outcomes of pancreatoenteric anastomosis when TAP ductal stent is inserted in small ducts (< or =3 mm).


CONCLUSIONS
There is insufficient evidence to support or refute improved outcomes after TAP ductal stent insertion in patients with PJ/PG with small ducts (< or =3 mm) or soft pancreata. More evidence of benefit is needed before use of external stents can be recommended.
Shukla
Parul J
PJ
Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai, India. pjshukla@doctors.org.uk
Barreto
Savio G
SG
Fingerhut
Abe
A
D000714:Anastomosis, Surgical; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000517:prevention & control* / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016896:Treatment Outcome