*division of hepatopancreatobiliary surgery, department of … · 2017. 5. 19. · roux-en-y...

Roux-en-Y Reconstruction after pancreaticoduodenectomy reduced gastrojejunostomy anastomosis-related complication Palin Limpavitayaporn MD.*, Ekkapak Sriussadaporn MD.*, Assignee Tongyoo MD.*, Chatchai Mingmalairak MD.* *Division of Hepatopancreatobiliary Surgery, Department of Surgery, Faculty of Medicine, Thammasat university, Pathumthani, Thailand. INTRODUCTION Pancreaticoduodenectomy has been accepted as a therapeutic option for patients with periampullary cancer since 1935. Post-operative pancreatic fistula is the most common complication, with the rate ranging from 5% to 40%. Gastrojejunostomy-related complication is not uncommon, such as marginal ulcer, bile reflux gastritis and afferent and efferent loop obstruction. OBJECTIVE The objective of this study was to review the experience of conventional reconstruction versus Roux-en-Y reconstruction after pancreaticoduodenectomy in a series of patients who underwent pancreatic head resection. MATERIALS AND METHODS We retrospectively reviewed and analyzed the data of the patients who had undergone pancreaticoduodenectomy with either conventional reconstruction or Roux-en-Y reconstruction techniques in Thammasat University Hospital between January 2012 and August 2016. RESULTS The overall incidence of post-operative pancreatic fistula was 15.7%, without significant difference in the two groups. Overall mortality, blood loss, operative time and length of stay were also similar in the two groups. The conventional reconstruction group had significantly higher rate of gastrojejunostomy-retaled complications such as afferent and efferent loop obstruction 21.6%, upper gastrointestinal bleeding caused from marginal ulcer 15.7%. (P<0.05) than the Roux-en-Y group. There were no gastrojejunostomy-related complications in the Roux-en-Y group. CONCLUSION Roux-en-Y reconstruction after pancreaticoduodenectomy had no significant difference in the rates of postoperative pancreatic fistula compared to conventional reconstruction. This technique reduced gastrojejunostomy-related complications such as marginal ulceration, afferent and efferent loop obstruction with significant difference compaired to conventional reconstruction. Conventional reconstruction Roux-en-Y reconstruction Normal anatomy - 1 years survival 89.8% - 3 years survival 58.5% - 5 years survival 53.2% Conventional (n = 11) Roux-en-Y (n = 40) P value POPF 3 (27%) 5 (12.5%) 0.346 Biliary leakage 0 1 (2.5%) 0.784 Marginal ulceration 3 (27%) 0 0.008 A/E loop obstruction 5 (45%) 0 0.003 Surgical site infection 3 (27%) 20 (50%) 0.305 Readmission within 60 days 4 (36%) 1 (2.5%) 0.006 The results comparison of conventional and Roux-en-Y reconstruction Kaplan-Meier curves for overall survival

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Roux-en-Y Reconstruction after pancreaticoduodenectomy reduced gastrojejunostomy anastomosis-related complication

Palin Limpavitayaporn MD.*, Ekkapak Sriussadaporn MD.*, Assignee Tongyoo MD.*, Chatchai Mingmalairak MD.*

*Division of Hepatopancreatobiliary Surgery, Department of Surgery, Faculty of Medicine, Thammasat university, Pathumthani, Thailand.

INTRODUCTION Pancreaticoduodenectomy has been accepted as a therapeutic option for patients with periampullary cancer since 1935. Post-operative pancreatic fistula is the most common complication, with the rate ranging from 5% to 40%. Gastrojejunostomy-related complication is not uncommon, such as marginal ulcer, bile reflux gastritis and afferent and efferent loop obstruction.

OBJECTIVE The objective of this study was to review the experience of conventional reconstruction versus Roux-en-Y reconstruction after pancreaticoduodenectomy in a series of patients who underwent pancreatic head resection.MATERIALS AND METHODS

We retrospectively reviewed and analyzed the data of the patients who had undergone pancreaticoduodenectomy with either conventional reconstruction or Roux-en-Y reconstruction techniques in Thammasat University Hospital between January 2012 and August 2016.RESULTS The overall incidence of post-operative pancreatic fistula was 15.7%, without significant difference in the two groups. Overall mortality, blood loss, operative time and length of stay were also similar in the two groups. The conventional reconstruction group had significantly higher rate of gastrojejunostomy-retaled complications such as afferent and efferent loop obstruction 21.6%, upper gastrointestinal bleeding caused from marginal ulcer 15.7%. (P