Abstract
Introduction: Many studies suggest PJ is better than PG in terms of long-term functional status. However, there are no clear recommendations regarding the specific PJ technique to be used, considering both the immediate and long-term outcome. Studies have proven Pengs PJ, a kind of invagination technique, to be better in terms of fistula rate for soft pancreas with small ducts. However, it has been criticized to cause exocrine and endocrine deficiencies because of accelerated atrophy of the remnant pancreas, adding to the burden of treatment. This happens due to an invagination kind of anastomosis which avoids the ductal bite that keeps the duct open from becoming stenotic as compared to duct to mucosa PJ. Method: At Asian Institute of Gastroenterology, Hyderabad, 27 patients were randomized using randomization allocation software-13 in binding and 14 in buchler PJ technique. The patients were followed-up for one year postoperatively for steatorrhoea, fecal elastase and OGTT. MRI triphasic+ MRCP (pancreatic protocol)- Anastamotic narrowing, Duct diameter, Remnant Pancreatic volume, Dixon sequences, DWI-ADC, fat content were noted. Result: 2/13 in binding group and 3/14 in buchler group had steatorrhoea. 7/12 in binding group and 8/12 in buchler group had deranged glucose tolerance tests. None were statistically different. There was no difference in fecal elastase levels. There was no difference in pancreatic morphological changes on MRI in both groups. Conclusion: The anastomosis of choice for soft pancreas with small duct post pancreaticoduodenectomy would be Pengs PJ as our study failed to show poor long-term results.
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