title: [Technical aspects of pancreatoenteric anastomosis].
abstract: Advances in pancreatic surgery during the last two decades have resulted in significant improvement of patient outcome leading to mortality rates as low as 3-5% following Whipple's procedure in specialized centers. However, morbidity remains considerably high at 30-50% which is primarily caused by insufficiency of the pancreato-enteric anastomosis which becomes manifested as a pancreatic fistula. Therefore, numerous studies have aimed to identify the ideal pancreatic anastomosis. The most frequently used techniques comprise end-to-end duct-to-mucosa pancreaticojejunostomy, end-to-end invagination pancreatojejunostomy as well as end-to-side pancreatogastrostomy. In randomized controlled trials the frequency of pancreatic fistulas ranges between 4% and 20% depending on the particular technique. However, no single technique was able to demonstrate a significant superiority in several independent studies. The heterogeneity of definitions for pancreatic fistula represents the main problem in evaluating and comparing clinical studies on pancreato-enteric anastomosis. However, recent clinical trials applied commonly accepted definitions for pancreatic fistula as well as precise study endpoints to address the question of the ideal pancreatic anastomosis.
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, St.-Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Deutschland.
authors.forename: A M
authors.initials: AM
authors.lastname: Chromik
authors.forename: D
authors.initials: D
authors.lastname: Sülberg
authors.forename: O
authors.initials: O
authors.lastname: Belyaev
authors.forename: W
authors.initials: W
authors.lastname: Uhl
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate