title: [Evidence-based supportive measures to secure pancreatic anastomoses].
abstract: BACKGROUND
  Pancreatic anastomosis is the Achilles heel of pancreatic surgery. Despite substantial progress in surgical techniques the rate of postoperative pancreatic fistulas remains very high. For this reason various supportive measures to secure pancreatic anastomoses are of continuing interest.
  
  
  OBJECTIVE
  This review presents the newest evidence-based data on supportive measures designed to secure a pancreatic anastomosis.
  
  
  METHODS
  The most recent meta-analyses, randomized controlled trials and the largest retrospective studies on the role of pancreatic duct stenting, double loop reconstruction, autologous patches and drainage in pancreaticoduodenectomy were taken into account. The value of somatostatin analogues, perioperative nutrition and fluid management is critically discussed.
  
  
  RESULTS
  The existing body of evidence on supportive measures is insufficient and remains controversial. The use of somatostatin analogues, drainages and restrictive perioperative fluid management has proven effective. In contrast, routine stenting of the pancreatic duct cannot be recommended. Other approaches, such as double loop reconstruction and use of autologous patches lack sufficient evidence.
  
  
  CONCLUSIONS
  Meticulous surgical technique and surgeon experience remain the cornerstones of performing a safe pancreatic anastomosis; however, some additional supportive measures seem to have significant potential and should be further investigated in large and well-designed prospective clinical trials.
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Ruhr-Universiät Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland. o.belyaev@klinikum-bochum.de.
authors.forename: O
authors.initials: O
authors.lastname: Belyaev
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Ruhr-Universiät Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Uhl
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D004322:Drainage / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D014868:Water Deprivation
chemical_list: D013004:Somatostatin
keywords: Ligamentum teres; Pancreatic fistula; Pancreaticoduodenectomy; Somatostatin analogue; Stent