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Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

Published on: June 17, 2018

Pancreaticojejunostomy: Does the technique matter? A randomized trial.

Anand N Singh¹, Sujoy Pal¹, Vivek Mangla¹

¹Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.

Journal of Surgical Oncology

|October 19, 2017

Summary

The duct-to-mucosa technique for pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD) shows no significant difference in preventing postoperative pancreatic fistula (POPF) compared to the dunking technique.

Keywords:

duct-to-mucosa dunking invagination pancreaticoduodenectomy pancreaticoenteric pancreaticojejunostomy pancreatoduodenectomy whipple

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Area of Science:

Surgical Oncology
Gastroenterology
Clinical Trials

Background:

The optimal method for pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD) remains a subject of debate in surgical literature.
Two prevalent PJ techniques, duct-to-mucosa and dunking, are commonly employed after PD for periampullary tumors.

Purpose of the Study:

To compare the efficacy of the duct-to-mucosa versus the dunking technique of PJ in reducing the incidence of postoperative pancreatic fistula (POPF).

Main Methods:

An open-label randomized trial conducted at a tertiary care center between January 2009 and October 2015.
193 patients undergoing PD for resectable periampullary tumors with a pancreatic duct diameter ≥2 mm were randomized to either duct-to-mucosa or dunking PJ.
The primary endpoint was the rate of POPF, with secondary analysis of other postoperative complications.

Main Results:

The overall POPF rate was 23.8% across both groups.
No statistically significant difference in POPF incidence was observed between the duct-to-mucosa (24.7%) and dunking (22.9%) groups (P=0.71).
Rates of clinically significant POPF (grades B and C) were also comparable (16.5% vs. 13.5%, P=0.57), as were other postoperative complications.

Conclusions:

The duct-to-mucosa PJ technique is not superior to the dunking technique in mitigating the risk of POPF after pancreaticoduodenectomy.
Both techniques demonstrate similar safety and efficacy profiles regarding POPF and overall complications.