Pancreaticojejunostomy for Pancreatico-enteric Anastomosis after Pancreaticoduodenectomy: one procedure with multiple techniques.
Rajesh Shinde, Rajgopal Acharya, Vikram Chaudhari, Manish Bhandare, Shailesh V. Shrikhande
Abstract
Pancreatico-enteric anastomoses after Pancreatico-duodenectomy (PD) has remained a true Achilles' heel in this complex and technically demanding operation. Multiple techniques have been described to achieve safe pancreatico-enteric drainage, however postoperative pancreatic fistula (POPF), still remains the major cause of morbidity. Pancreatico-jejunostomy (PJ) is commonly performed procedure for this purpose, however there are lot of variations in PJ techniques. Herein, we intend to review the commonly practised PJ techniques with emphasis on technical variations and reported outcomes. Literature review suggest that, there is no single, universally accepted or gold standard technique for this purpose. Pancreatic surgeons should be aware of technical aspects of different techniques, so that they can choose the best suited technique as per the clinical scenario.