• Laureano Fernández-Cruz.
• Department of Surgery, ICMDM, Hospital Clínic de Barcelona, University of Barcelona, Villarroel 170, Escalera 6, 4th Floor, 08036, Barcelona, Spain. lfcruz@clinic.ub.es
• J Hepatobiliary Pancreat Sci. 2011 Nov 1; 18 (6): 762-8.

Background/PurposeIn the majority of reports morbidity after pancreaticoduodenectomy remains high and leakage from the pancreatic stump still accounts for the majority of surgical complications. Many technical modifications of the pancreaticoenteric anastomosis to decrease the pancreatic leakage rate have been suggested.MethodsA Medline search for surgical guidelines, prospective randomized controlled trials, systematic meta-analyses, and clinical results was performed with regard to technical aspects of reconstruction, i.e., pancreaticojejunostomy versus pancreaticogastrostomy, after pancreaticoduodenectomy. Here we illustrate the different approaches to reconstruction, with an emphasis on technical aspects and their details.ConclusionsPancreaticojejunostomy appears to be the most widely performed reconstruction, but pancreaticogastrostomy is a reasonable alternative. However, in the analysis of the clinical results it is important to know which specific pancreaticoenteric anastomosis is considered; for example, end-to-end, dunking, invagination of the pancreatic stump, or duct-to-mucosa. It is hoped that collaborative trials will provide high-level data to allow tailoring of the operative technique, depending on the risk factors for pancreatic leakage in any particular patient.© 2011 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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