title: Which is the best technique for pancreaticoenteric reconstruction after pancreaticoduodenectomy? A critical analysis.
abstract: The definitive surgical management of periampullary tumors is a challenging endeavor. This article reviews the available data on the efficacy of various methods of pancreaticoenteric reconstruction designed for the prevention of pancreatic fistula (PF). A literature search of the Medline database was used to identify randomized controlled trials (RCTs) that compared pancreaticojejunostomy (PJ) with pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD). A total of two metaanalyses and four prospective RCTs were identified. Individual RCTs comparing PJ and PG allow the surgeons participating in the trial to choose technical modifications of one particular technique. As a result, there is no universal agreement as to whether one particular variation is safer and less prone to PF than the others. In addition, the majority of RCTs failed to stratify patient risk of PF. Further studies are therefore necessary to define the optimal technique of pancreatic reconstruction after PD conducted in high-volume centers by high-volume surgeons.
authors.affiliation: Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Laureano
authors.initials: L
authors.lastname: Fernández-Cruz
authors.forename: Andrea
authors.initials: A
authors.lastname: Belli
authors.forename: Mario
authors.initials: M
authors.lastname: Acosta
authors.forename: Enrique Jiménez
authors.initials: EJ
authors.lastname: Chavarria
authors.forename: Waldemar
authors.initials: W
authors.lastname: Adelsdorfer
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: López-Boado
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
mesh_terms: D014670:Ampulla of Vater; D000714:Anastomosis, Surgical / Q000379:methods*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D006801:Humans; D015201:Meta-Analysis as Topic; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000517:prevention & control; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D013270:Stomach / Q000601:surgery*