Evaluation of the Different Methods of Pancreatic Reconstruction after PancreaticoduodenectomyA Prospective Randomized Study

Introduction: Pancreatico-Duodenectomy (PD) is consid-ered the corner stone in the management of pancreatic head and periampullary neoplasms. Pancreatic anastomosis is the most critical and challenging step in the procedure and considered an Achilles heel. Post-Operative Pancreatic Fistula (POPF) is the most feared complication being responsible for most of the post-operative morbidity and mortality.Patients and Methods: Between January 2013 and December 2014, 60 patients who underwent PD for various benign and malignant diseases of the pancreatic head and the periampullary region at Gastroenterology Surgical Center, Mansoura University, were enrolled for the study. Patients were randomly assigned to three groups of pancreatic reconstruction (Pancreaticogastrostomy (PG), simple loop pancreaticojejunostomy and isolated loop Pancreaticojejunostomy) (PJ) 20 patients in each group. The primary end point was the incidence and severity of post-operative pancreatic fistula.Results: POPF occurred in 11 cases in the total 60 cases of the study (18.3%). Although POPF occurred the least with PG, there was no significant difference in the incidence of POPF between the three groups (p=0.46). Regarding the severity of leak, two cases in the isolated loop PJ group had grade C POPF, however, there was no significant difference among the groups for the grade of pancreatic fistula (p=0.17).Conclusion: After data analysis of our study, we conclude that no significant difference exist between PG, simple loop PJ and isolated loop PJ regarding the rate and severity of POPF. However, more RCTs are required to confirm our results.