AbbreviationsDGEdelayed gastric emptyingECOGeastern cooperative oncology groupISGPFinternational study group for pancreatic fistulaPDpancreaticoduodenectomyPJpancreaticojejunostomyPOPFpostoperative pancreatic fistulaPPHpost‐pancreatectomy hemorrhageINTRODUCTIONThe success of pancreaticoduodenectomy (PD) rests primarily on the technical and functional outcome of the pancreaticoenteric anastomosis. Pancreaticoenteric anastomotic leak contributes most to the morbidity and mortality after PD, either directly or indirectly. Pancreaticojejunostomy (PJ) is one of the two widely used reconstruction techniques, pancreaticogastrostomy being the other technique. PJ has advantages such as a physiological nature, lower incidence of post‐pancreatectomy hemorrhage, lower morbidity of a postoperative pancreatic fistula (POPF) if it occurs and better long‐term outcomes in terms of pancreatic exocrine insufficiency and nutritional status of the patient. The two conventional techniques of reconstruction for a PJ are dunking (invagination) and duct‐to‐mucosa techniques, each having a number of modifications. The dunking technique has the advantage of complete drainage of the pancreatic duct as well as the stump. However, the need to mobilize a long length of pancreatic stump and placement of circumferential sutures results in disruption and impairment of the stumps's blood supply. In contrast, the advantages of the duct‐to‐mucosa technique are assured drainage of the main duct into the intestine and on long‐term follow up, preservation of patency of the duct. However, it does
Journal of Surgical Oncology – Wiley
Published: Jan 1, 2018
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