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Double purse-string telescoped pancreaticogastrostomy is not superior in preventing pancreatic fistula development in high-risk anastomosis: a 6-year single-center case–control study

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Abstract

Purpose

The double purse-string telescoped pancreaticogastrostomy (PG) technique has been suggested as an alternative approach to reduce the risk of postoperative pancreatic fistula (POPF). Its efficacity in high-risk situations has not yet been explored. This study compared the incidence of clinically relevant POPF (CR-POPF) between patients with high-risk anastomosis undergoing PG and those undergoing pancreaticojejunostomy (PJ).

Methods

From 2013 to 2019, 198 consecutive patients with high-risk anastomosis, an updated alternative fistula risk score > 20%, and who underwent pancreatoduodenectomy with the PJ (165) or PG (33) technique were included. Optimal mitigation strategy (external stenting/octreotide omission) was applied for all patients. The primary endpoint was the incidence of CR-POPF.

Results

The mean ua-FRS was 33%. CR-POPF (grade B/C) was found in 42 patients (21%) and postoperative hemorrhage in 30 (15%); the mortality rate was 4%. CR-POPF rates were comparable between the PJ (19%) and PG (33%) groups (P = 0.062). The PG group had a higher rate of POPF grade C (24% vs. 10%; P = 0.036), longer operative time (P = 0.019), and a higher transfusion rate (P < 0.001), even after a matching process on ua-FRS.

In the multivariate analysis, the type of anastomosis (P = 0.88), body mass index (P = 0.47), or main pancreatic duct diameter (P = 0.7) did not influence CR-POPF occurrence.

Conclusions

For patients with high-risk anastomosis, the double purse-string telescoped PG technique was not superior to the PJ technique for preventing CR-POPF.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author on reasonable request.

Code availability

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Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France

    Jonathan Garnier, Jacques Ewald, Ugo Marchese & Anais Palen

  2. Department of Intensive Care, Institut Paoli-Calmettes, Marseille, France

    Djamel Mokart

  3. Department of Interventional Radiology, Institut Paoli-Calmettes, Marseille, France

    Gilles Piana

  4. Department of Surgical Oncology, Aix-Marseille University, Institut Paoli-Calmettes, CRCM, Marseille, France

    Jean-Robert Delpero & Olivier Turrini

Authors
  1. Jonathan Garnier
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  2. Jacques Ewald
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  3. Ugo Marchese
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  4. Anais Palen
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  5. Djamel Mokart
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  6. Gilles Piana
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  7. Jean-Robert Delpero
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  8. Olivier Turrini
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Contributions

Study conception and design: Garnier, Turrini, Ewald, Mokart. Acquisition of data: Garnier, Turrini, Palen, Marchese, Mokart, Piana. Analysis and interpretation: Garnier, Turrini, Ewald, Palen, Mokart. Writing—Original Draft Preparation: Garnier, Delpero. Critical revision of manuscript: Ewald, Marchese, Delpero, Turrini, Piana.

Corresponding author

Correspondence to Jonathan Garnier.

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Ethics approval

The study protocol adhered to the tenets of the Declaration of Helsinki and was approved by Institutional Review Boards (GASTROPAN-IPC 2020-029).

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The study participants provided written informed consent, and the study was registered at ClinicalTrial.gov (NCT04724174).

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All authors declare no competing interests.

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Garnier, J., Ewald, J., Marchese, U. et al. Double purse-string telescoped pancreaticogastrostomy is not superior in preventing pancreatic fistula development in high-risk anastomosis: a 6-year single-center case–control study. Langenbecks Arch Surg 407, 1073–1081 (2022). https://doi.org/10.1007/s00423-021-02376-6

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