Resection in Chronic Pancreatitis: Anastomosis with the Jejunum or with the Stomach?

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C. BASSI, M. FALCONI, T. TIHANY, R. SALVIA, A. VALERIO, E. CALDIRON, M. ABU HILAL, L.E. FLAUTNER , P. PEDERZOLI

Ann. Ital. Chir., LXXI, 1, 2000

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Even in centers where the first choice in the surgical treatment of chronic pancreatitis is a derivative procedure some selected patients require resection. The most popular solution of gastrointestinal reconstruction still seems to be pancreaticojejunostomy but, the review of the reported experiences, suggests a general trend towords anastomosis with the stomach as a recent policy. A reliable comparison between pancreaticogastrostomy and pancreaticojejunostomy is difficult because the reported series are seldom related to chronic pancreatitis patients only, but are reporting mixed date concerning mainly periampullory cancer. Moreover with only one exception no prospective randomised clinical trails are available; unfortunately the positive trend in favour of pancreaticogastrostomy reported in uncontrolled studies is not confirmed in the randomised setting. Also the comparison between the experiences achieved by the present authors working in centers with different approach to the pancreatic anastomosis does not show statistical significant difference for both morbidity and mortality. In conclusion nowday the best confidence and experience with any of the two methods rapresents the basis of choice.