title: Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study.
abstract: BACKGROUND
  The ideal technical pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debated. The aim of the study was to assess the surgical outcomes of duct to mucosa pancreaticojejunostomy (PJ) (G1) and invagination PJ (G2) after PD.
  
  
  METHODS
  Consecutive patients treated by PD at our center were randomized into either group. The primary outcome measure was the rate of postoperative pancreatic fistula (POPF); secondary outcomes included; operative time, day to resume oral feeding, postoperative morbidity and mortality, exocrine and endocrine pancreatic functions.
  
  
  RESULTS
  One hundred and seven patients treated by PD were randomized. The median operative time for reconstruction was significantly longer in G1 (34 vs. 30 min, P=0.002). POPF developed in 11/53 patients in G1 and 8/54 patients in G 2, P=0.46 (6 vs. 2 patients had a POPF type B or C, P=0.4). Steatorrhea after one year was 21/50 in G1 and 11/50 in G2, respectively (P=0.04). Serum albumin level after one year was 3.4 gm% in G1 and 3.6 gm in G2 (P=0.03). There was no statistically significant difference regarding the incidence of DM preoperatively and one year postoperatively.
  
  
  CONCLUSIONS
  Invagination PJ is easier to perform than duct to mucosa especially in small pancreatic duct. The soft friable pancreatic tissue can be problematic for invagination PJ due to parenchymal laceration. Invagination PJ was not associated with a lower rate of POPF, but it was associated with decreased severity of POPF and incidence of postoperative steatorrhea. CLINICAL TRIALS.
  NCT02142517.
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. Electronic address: elnakeebayman@yahoo.com.
authors: Ayman
authors: A
authors: El Nakeeb
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: El Hemaly
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Waleed
authors: W
authors: Askr
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: Abd Ellatif
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Hosam
authors: H
authors: Hamed
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Ahmed
authors: A
authors: Elghawalby
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: Attia
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Tallat
authors: T
authors: Abdallah
authors: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed
authors: M
authors: Abd ElWahab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012086:Reoperation; D055815:Young Adult
keywords: Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy