[Evidence-based supportive measures to secure pancreatic anastomoses]

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Oncology

Background:

• Pancreatic anastomosis remains a significant challenge in pancreatic surgery, with high rates of postoperative pancreatic fistulas.
• Despite advancements, securing pancreatic anastomoses effectively is an ongoing area of research and clinical interest.

Purpose of the Study:

• To review the latest evidence-based data on supportive measures for securing pancreatic anastomoses.
• To critically evaluate the efficacy of various interventions in reducing pancreatic fistula rates.

Main Methods:

• Systematic review of recent meta-analyses, randomized controlled trials, and large retrospective studies.
• Analysis focused on pancreatic duct stenting, double loop reconstruction, autologous patches, drainage, somatostatin analogues, perioperative nutrition, and fluid management in pancreaticoduodenectomy.

Main Results:

• Evidence for supportive measures is often insufficient and debated.
• Somatostatin analogues, drainage, and restrictive perioperative fluid management demonstrated effectiveness.
• Routine pancreatic duct stenting is not advised; double loop reconstruction and autologous patches lack robust evidence.

Conclusions:

• Meticulous surgical technique and surgeon experience are paramount for safe pancreatic anastomosis.
• Certain supportive measures show potential but require further investigation in large prospective trials.