Pancreatic reconstruction techniques after pancreaticoduodenectomy: a review of the literature

ABSTRACT

Introduction: Postoperative pancreatic fistula is the most troublesome complication after pancreaticoduodenectomy, and is an on-going area of concern for pancreatic surgeons. The specific pancreatic reconstruction technique is an important factor influencing the development of postoperative pancreatic fistula after pancreaticoduodenectomy.

Areas covered: In this paper, we briefly introduced the definition and relevant influencing factors of postoperative pancreatic fistula. We performed a search of all meta-analyses published in the last 5 years and all published randomized controlled trials comparing different pancreatic anastomotic techniques, and we evaluated the advantages and disadvantages of different techniques.

Expert opinion: No individual anastomotic method can completely avoid postoperative pancreatic fistula. Selecting specific techniques tailored to the patient’s situation intraoperatively may be key to reducing the incidence of postoperative pancreatic fistula.

KEYWORDS:

• Duct-to-mucosa
• invagination
• pancreaticoduodenectomy
• pancreaticogastrostomy
• pancreaticojejunostomy
• postoperative pancreatic fistula
• stent

Article highlights

• The risk factors for postoperative pancreatic fistula are multiple and complex, and include patient-related factors, pancreatic factors, surgical factors and perioperative management factors.

• The incidence rate of postoperative pancreatic fistula after invagination pancreaticojejunostomy is similar to that after duct-to-mucosa pancreaticojejunostomy. The two methods have their own advantages and disadvantages.

• Pancreaticogastrostomy is another safe pancreatic anastomotic method with an incidence of postoperative pancreatic fistula similar to that after pancreaticojejunostomy.

• External pancreatic duct stents may reduce the rate and severity of postoperative pancreatic fistula in the setting of high-risk pancreatic anastomosis.

Acknowledgments

We thank Jane Charbonneau, DVM and Angela Morben, DVM, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Declaration of interest

The authors report no conflicts of interest.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the grant of the Second Hospital of Jilin University.