title: Pancreatic fistulae after a pancreatico-duodenectomy: are pancreatico-gastrostomies safer than pancreatico-jejunostomies? An expertise-based trial and propensity-score adjusted analysis.
abstract: BACKGROUND
  A pancreatic fistula (PF) is a major contributor to morbidity and mortality after a pancreaticoduodenectomy (PD). There remains debate as to whether re-establishing pancreaticoenteric continuity by a pancreatico-gastrostomy (PG) can decrease the risk of a PF and complications compared with a pancreatico-jejunostomy (PJ). The outcomes of patients undergoing these reconstructions after a PD were compared.
  
  
  METHODS
  Patients undergoing a PD between 1999 and 2011 were selected from a prospective database and having undergone either a PG or PJ reconstruction. A propensity-score adjusted multivariate logistic regression was performed to identify the effect of surgical technique on outcomes of PF, delayed gastric emptying (DGE) and total complications.
  
  
  RESULTS
  Twenty-three out of 103 and 20 out of 103 (P = 0.49) patients had PF and 74 out of 103 and 55 out of 103 patients had all-grades DGE in the PG and PJ groups, respectively (P = 0.02). The groups did not differ with regards to Clavien-Dindo grade of complications (P = 0.29) but did differ with regards to the Comprehensive Complication Index (CCI) (38.4 versus 31.4 for PG versus PG, respectively, P = 0.02.) Propensity-score adjusted multivariate analysis showed no effect of PG on PF (P = 0.89), DGE grades B/C (P = 0.9) or CCI (P = 0.41). There remained an effect on all-grades of DGE (P = 0.012.)
  
  
  CONCLUSIONS
  Patients undergoing PG reconstruction had a similar rate of PF as those undergoing a PJ after a PD.
authors.affiliation: Department of General Surgery, McGill University, Montreal, QC, Canada.
authors.forename: Jad
authors.initials: J
authors.lastname: Abou Khalil
authors.forename: Nancy
authors.initials: N
authors.lastname: Mayo
authors.forename: Sinziana
authors.initials: S
authors.lastname: Dumitra
authors.forename: Mohammed
authors.initials: M
authors.lastname: Jamal
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barkun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D057216:Propensity Score; D011792:Quebec; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult