title: Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy.
abstract: OBJECTIVE
  A 2011 metaanalysis demonstrated no difference in postoperative complications between pancreatogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy with the limitation of heterogeneity among the analysed studies. The present study compares postoperative complications after duct-to-mucosa pancreaticojejunostomy with a modified binding purse-string-mattress sutures pancreatogastrostomy in a teaching hospital.
  
  
  METHODS
  One-hundred consecutive pancreaticoduodenectomies were reconstructed either by pancreaticojejunostomy (n = 50, 2004-2008) or modified pancreatogastrostomy (n = 50, 2008-2011). Prospective patients' data was retrospectively analysed for postoperative complications.
  
  
  RESULTS
  Complications occurred significantly less after modified pancreatogastrostomy compared to pancreaticojejunostomy (p = 0.016). This was mainly due to a significantly lower rate of pancreatic fistula (p = 0.029), especially a lower rate of clinically relevant B and C fistulas (p = 0.011). In particular, the fistula rate was reduced in patients with a soft, non-fibrotic pancreas (p = 0.0231). Postoperative mortality was also lower after modified pancreatogastrostomy (p = 0.042). Uni- and multivariate analyses revealed a soft, non-fibrotic pancreatic texture (odds ratio 5.4, p = 0.028), a non-dilatated pancreatic duct (p = 0.047) and pancreaticojejunostomy (odds ratio 10.7, p = 0.026) as independent, negative factors for pancreatic fistula.
  
  
  CONCLUSIONS
  In a teaching hospital, modified pancreatogastrostomy seems to be superior to pancreaticojejunostomy regarding pancreatic fistula, especially in patients with a soft, non-fibrotic pancreas and/or a small duct. An ongoing prospective randomised multicentre trial (RECOPANC) might confirm these results.
authors.affiliation: Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043 Marburg, Germany. Electronic address: dietzel@med.uni-marburg.de.
authors.forename: Kristin
authors.initials: K
authors.lastname: Heeger
authors.forename: Volker
authors.initials: V
authors.lastname: Fendrich
authors.forename: Jens
authors.initials: J
authors.lastname: Waldmann
authors.forename: Peter
authors.initials: P
authors.lastname: Langer
authors.forename: Veit
authors.initials: V
authors.lastname: Kanngießer
authors.forename: Detlef Klaus
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000714:Anastomosis, Surgical; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Pancreatogastrostomy