{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T07:29:02Z","timestamp":1761290942751},"reference-count":42,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2010,3,24]],"date-time":"2010-03-24T00:00:00Z","timestamp":1269388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2010,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pancreatic fistula (PF) is the main cause of postoperative morbidity and mortality after pancreatectomy. Two reasons for PF are a \u201csoft\u201d pancreatic texture and a narrow pancreatic duct (high\u2010risk gland). Pancreaticojejunostomy (PJ) may lead to a higher fistula rate in such glands. In the literature there are no data available on risk\u2010adapted assignment of pancreatogastrostomy (PG) in a high\u2010risk gland. Therefore, an observational pilot study was conducted to address this issue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Since January 2007 the concept of a \u201crisk\u2010adapted pancreatic anastomosis\u201d (RAP) was introduced (PG for high\u2010risk glands). The PF rate, morbidity, and mortality during this period (January 2007 to December 2008, <jats:italic>n<\/jats:italic> = 74) were compared to those between January 2004 and December 2006 (<jats:italic>n<\/jats:italic> = 119, only PJ). PF was defined according to the International Study Group on Pancreatic Surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Through RAP the PF rate was reduced from 22 to 11% (<jats:italic>P<\/jats:italic> = 0.0503). Grade C PF rate was reduced from 6.7 to 1.4% (<jats:italic>P<\/jats:italic> = 0.1569) and grade A PF from 6 to 1.4% (<jats:italic>P<\/jats:italic> = 0.2537). The PF\u2010associated mortality was reduced from 3.4 to 1.4%. PG revealed a PF rate of 7% and PJ accounted for 19% of PFs (<jats:italic>P<\/jats:italic> = 0.1765). There was no incidence of grade C PF following PG. The incidence of intraluminal hemorrhage (<jats:italic>P<\/jats:italic> = 0.0422) and delayed gastric emptying (<jats:italic>P<\/jats:italic> = 0.0572) was higher following PG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The rate of PF could be significantly reduced with the use of RAP. One should be cautious about the indication for PG, since it is associated with a higher rate of intraluminal hemorrhage and delayed gastric emptying. There are no long\u2010term results on PG with respect to its durability and function. A general recommendation for its use cannot currently be made.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-010-0521-5","type":"journal-article","created":{"date-parts":[[2010,3,23]],"date-time":"2010-03-23T14:44:18Z","timestamp":1269355458000},"page":"1579-1586","source":"Crossref","is-referenced-by-count":20,"title":["Risk\u2010Adapted Anastomosis for Partial Pancreaticoduodenectomy Reduces the Risk of Pancreatic Fistula: A Pilot Study"],"prefix":"10.1002","volume":"34","author":[{"given":"Marco","family":"Niedergethmann","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Mannheim University Medical Center Mannheim, University of Heidelberg 68135 Mannheim Germany"},{"name":"Department of Surgery University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim\/University of Heidelberg Theodor\u2010Kutzer\u2010Ufer 1\u20103 68167 Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niloufar","family":"Dusch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Mannheim University Medical Center Mannheim, University of Heidelberg 68135 Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rizky","family":"Widyaningsih","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Mannheim University Medical Center Mannheim, University of Heidelberg 68135 Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christel","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Biomathematics, Faculty of Medicine Mannheim University Medical Center Mannheim, University of Heidelberg 68135 Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Kienle","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Mannheim University Medical Center Mannheim, University of Heidelberg 68135 Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Post","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Mannheim University Medical Center Mannheim, University of Heidelberg 68135 Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,3,24]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605\u2010008\u20100534\u20107"},{"key":"e_1_2_6_3_2","first-page":"175","article-title":"Postoperative complications of pancreatic cancer surgery","volume":"59","author":"Niedergethmann M","year":"2004","journal-title":"Minerva Chir"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010002\u20106659\u2010z"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2006.12.001"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605\u2010007\u20100270\u20104"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2005.08.029"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010006\u20100052\u20101"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v11.i16.2456"},{"key":"e_1_2_6_10_2","first-page":"1831","article-title":"Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. 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