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Invited Commentary
February 26, 2020

Does Pancreaticogastrostomy Reduce the Risk of Postoperative Pancreatic Fistula After Pancreatoduodenectomy?

Author Affiliations
  • 1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
  • 2Hepatopancreaticobiliary/Upper Gastrointestinal Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
  • 3Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
JAMA Surg. 2020;155(4):321-322. doi:10.1001/jamasurg.2019.6036

Pancreaticoduodenectomy is a complex operation that has become safer over the past 3 decades but is still associated with a high complication rate. Much of this morbidity is attributable to leakage of the pancreatic anastomosis and the ensuing postoperative pancreatic fistula (POPF), which contributes to deep-space infection, delayed gastric emptying, hemorrhage, and systemic complications, including septic shock, organ failure, and death. Many groups have sought to reduce the risk of POPF using novel anastomotic techniques, topical agents, and medical treatments. A fundamental technical variation is whether the pancreas is anastomosed to the jejunum or the stomach.

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