The reconstruction after pylorus preserving pancreatoduodenectomy: pancreatogastrostomy with Roux-en-Y reconstruction versus conventional Traverso type reconstruction

Joji Yamamoto, Yoshiaki Shimizu, Motoki Nagai, Harufumi Makino, Shigehiro Kojima, Yuuki Ozamoto

Kamagaya General Hospital Japan.
Kamagaya General Hospital,Japan.

DOI: 10.4236/health.2010.23028                

Abstract

Objective: To compare the result of pancreatogastrostomy (PG) with Roux-en-Y reconstruction versus pancreatojejunostomy (PJ) with conventional Traverso-type reconstruction following pylorus-preserving pancreatectomy (PP- PD) in a retrospective study. PPPD has been accepted as a radical surgical treatment for malignant periampullary neoplasms. However, the reconstruction of this surgery is technically complicated. The leakage of pancreatic juice and the delayed gastric emptying are the major complications of PPPD and may be fatal. To solve these problems, we have performed PG with Roux-en-Y anastomosis. There are several techniques proposed the reconstruction after PPPD, however there have been no previous study describing the result of PG with Roux- en-Y anastomosis. Since 2002 we have perfor- med 32 cases of PPPD. They were divided into two groups according to the reconstruction procedures: PG with Roux-en-Y reconstruction (group PG-RY) (17 cases) and pancreatojejunostomy with Traverso-type reconstruction (group PJ-T) (15 cases). Results: Patient age, gender, and underlying disease were comparable among the groups. Two groups showed no differences in intraoperative bleeding amount, and the time of surgery. The occurrence of the pancreatic leakage was significantly reduced in the group PG-RY compared with the group PJ-T. There was no case of the delayed gastric emptying in the group PGRY. Conclusions: Pancreatogastrosotmy with Roux-en-Y anastomosis can reduce the occurrence of the pancreatic leakage and delayed gastric emptying following pylorus-preserving pancreatoduodenectomy.

Keywords

Pancreatoduodenectomy; Pancreatogastrostomy; Roux-en-Y Reconstruction; Pancreatojejunostomy; Traverso-Type Reconstruction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	National survey of pancreatic cancer in Japan 1999 (written in Japanese) (2001) Pancreas, 16, 115-147.
[2]	Takahata, S., Ohtsuka, T., Nabae, T., et al. (2002) Comparison of recovery of gastric Phase III motility and gastric juice output after different types of gastrointestinal reconstruction following pylorus-preserving pancreatoduodenectomy. Journal of Gastroenterol, 37, 596-603.
[3]	Yeo, C.J., Cameron, J.L., Maher, M.M., et al. (1995) A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduode- nectomy. Annals of surgery, 222, 580-588.
[4]	Fujino, Y., Suzuki, Y., Ajiki, T., et al. (2002) Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital. Hepato-Gastroenterology, 49, 1124-1129.
[5]	Yeo, C.J., Cameron, J.L., Lillemoe, K.D., et al. (2000) Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Annals of surgery, 232, 419-429.
[6]	Suc, B., Msika, S., Fingerhut, A., et al. (2003) Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intraabdominal complications after pancreatic resection. Annals of surgery, 237, 57-65.
[7]	Fromm, D. and Schwarz, K. (2003) Ligation of the pancreatic duct during difficult operative circumstances. Journal of the American College of Surgery, 197, 943- 948.
[8]	Delcore, R., Thomas, J.H., Pierce, G.E., et al. (1990). Pancreatogastrostomy: A safe drainage procedure after pancreatoduodenectomy. Surgery, 108, 641-645.
[9]	Yamamoto, J., Shimamura, Y., Nakahara, H., et al. (1997) Simple technique for pancreatogastrostomy and the histological findings of pancreatogastric anastomosis. Archives of surgery, 132, 785-788.
[10]	Pikarsky, A.J., Muggia-Sullum, M., Eid, A., et al. (1997) Pancreaticogastrostomy after pancreatoduodenectomy. Archives of surgery, 132, 296-299.
[11]	Weller, U., Makowiec, F., Fischer, E., et al. (2009) Reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy. Journal of Gastrointestinal Surgery, 13, 745-751.
[12]	Conlon, K.C., Labow, D., Leung, D., et al. (2001) Prospective randamized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Archives of surgery, 234, 487-494.
[13]	Duffas, J.P., Msika, S., Fourtanier, G., et al. (2005) A controlled multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. American Journal of Surgery, 189, 720-729.