Pancreaticogastrostomy Versus Pancreaticojejunostomy With Dunking Technique After Pancreaticodudenectomy: A Prospective Randomized Comparative Study

• Conditions: Pancreaticobiliary Cancer
• Interventions: Procedure: Pancreaticogastrostomy versus Pancreaticojejunostomy with Dunking Technique

• Registration Number: NCT05171361
• Lead Sponsor: Assiut University

Brief Summary

To compare between the outcomes of pancreaticogastrostomy and pancreaticojejunostomy with dunking technique after Pancreaticodudenectomy in the treatment of operable periampullary malignancies.

Detailed Description

Pancreaticoduodenectomy remains the treatment of choice for periampullary malignancies. Advances in pancreatic surgery techniques and perioperative care have led to reduced mortality rates for Pancreaticodudenectomy \[1\]. However, morbidity after pancreatic resection remains high, with 30-60% of patients experiencing complications following surgery, mainly as a result of leak and subsequent fistula from the pancreatic anastomosis \[2\].The leakage of the pancreatic anastomosis remains the most serious problem as it is the major cause of morbidity after pancreaticoduodenectomy, and also contributes significantly to prolonged hospitalization \[5\]. For this reason, surgeons have always directed their efforts at reducing the rate of pancreatic fistula through the introduction of new and effective methods of construction of the pancreatic anastomosis \[6\]. Various techniques have been described for joining the pancreatic stump either with the jejunum or with the stomach, with or without internal or external drainage of the pancreatic duct. Recently, new prospective randomized studies have demonstrated the advantage of pancreaticogastrostomy over pancreaticojejunostomy in reducing the incidence of pancreatic fistula \[3\]; however, none of these techniques has proved to be superior in minimizing postoperative mortality and morbidity \[4\]. One of the difficulties of pancreatic reconstruction after pancreaticoduodenectomy is the presence of soft pancreas which leads to high risk of fistula so dunking technique was raised \[8\]. But few researches or papers have focused on its efficacy and even fewer papers have discussed dunking in pancreaticogastrostomy and pancreaticojejunostomy, So this is the interest of our study to compare between the efficacies of these two techniques.

Study Timeline

• Status Verified: 2021-12
• Study First Submitted: 2021-12-10
• Study First Submitted QC: 2021-12-27
• Last Update Submitted: 2021-12-27
• Study First Posted: 2021-12-28
• Last Update Posted: 2021-12-28
• Study Start: 2022-03
• Primary Completion: 2023-03
• Study Completion: 2023-04

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• All cases of resectable periampullary carcinomas (cancer head of pancreas, ampullary carcinoma, distal cholangiocarcinoma and second part of duodenum adenocarcinoma) that are surgically fit according to ASA.

Exclusion Criteria

• 1. Surgically unfit cases according to ASA 2. Locally advanced irresectable cases

• Abutment or encasement of coeliac trunk

• Encasement of SMA less than 180 degree of its axis

• Encasement of portal/SMV more than 180 degree of its axis or infiltration segment too long more than 2.5 cm that the remaining segment will not coapts after resection.

  3. Metastatic disease

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Pancreaticogastrostomy	Pancreaticogastrostomy versus Pancreaticojejunostomy with Dunking Technique	With Dunking Technique after Pancreaticodudenectomy
Pancreaticojejunostomy	Pancreaticogastrostomy versus Pancreaticojejunostomy with Dunking Technique	With Dunking Technique after Pancreaticodudenectomy

Primary Outcome Measures

Name	Time	Method
Rate of postoperative anastomosis leakage	One month	Compare between dunking in pancreaticogastrostomy and pancreaticojejunostomy and the rate of postoperative anastomosis leakage