{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:04:20Z","timestamp":1753887860712,"version":"3.41.2"},"reference-count":24,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABCD, arq. bras. cir. dig."],"abstract":"<jats:p>ABSTRACT - BACKGROUND: Several methods have been proposed for the reconstruction of digestive transit after pancreatoduodenectomy. Biliary anastomosis positioned before gastric anastomosis helps reduce postoperative reflux and cholangitis.  AIMS:  The objective of this study was to present the anatomical sequence of gastric and biliary continuity after pancreatoduodenectomy in patients with pancreatic tumor and to evaluate the short- and long-term results in an initial series of cases.  METHODS:  Two techniques were used: one with Roux-en-Y reconstruction and pancreaticojejunostomy and the other with a single jejunal loop and pancreatogastroanastomosis. In both the cases, the gastric anastomosis was placed performed before the biliary one. An analysis of demographic data, Wirsung\u2019s duct and common bile duct dilatation, the use of percutaneous drainage, and postoperative complications was carried out.  RESULTS:  A total of seven patients (four men and three women), with a mean age of 62 years, underwent surgery. All cases had Wirsung\u2019s duct and common bile duct dilatation. A percutaneous external biliary drainage was performed in four patients. There were three postoperative complications: one related to delayed gastric emptying and two related to wound infections. During a median follow-up of 12 months, no episode of cholangitis was recorded.  CONCLUSIONS:  Elevated percentages of cholangitis are reported in different reconstructions after pancreatoduodenectomy, and it is difficult to conclude reflux as the main etiology. The proposed gastric and biliary reconstructions show conforming results, facilitating posterior endoscopic access. Late follow-up and large number of cases may help assess whether the etiology of postoperative cholangitis is reflux or other factors unrelated to the order of the anastomoses.<\/jats:p>","DOI":"10.1590\/0102-672020220002e1688","type":"journal-article","created":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T18:23:44Z","timestamp":1663352624000},"source":"Crossref","is-referenced-by-count":0,"title":["IS THE ANATOMICAL SEQUENCE OF GASTRIC AND BILIARY ANASTOMOSIS IN THE PANCREATODUODENECTOMY RECONSTRUCTION THE CAUSE OF AN INCREASE IN THE INCIDENCE OF CHOLANGITIS? A TECHNICAL VARIANT PRESENTATION AND INITIAL RESULTS"],"prefix":"10.1590","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2559-5704","authenticated-orcid":false,"given":"Gustavo Adrian","family":"NARI","sequence":"first","affiliation":[{"name":"Transito Caceres de Allende Hospital,  Argentina; La Canada Sanatorium,  Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8412-6265","authenticated-orcid":false,"given":"Alesio","family":"LOPEZ","sequence":"additional","affiliation":[{"name":"Transito Caceres de Allende Hospital,  Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2723-0765","authenticated-orcid":false,"given":"Jose Luis","family":"LAYUN","sequence":"additional","affiliation":[{"name":"La Canada Sanatorium,  Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-8400","authenticated-orcid":false,"given":"Daniela","family":"MARIOT","sequence":"additional","affiliation":[{"name":"La Canada Sanatorium,  Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-175X","authenticated-orcid":false,"given":"Flavia","family":"LOPEZ","sequence":"additional","affiliation":[{"name":"Transito Caceres de Allende Hospital,  Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4619-4149","authenticated-orcid":false,"given":"Maria Eugenia","family":"DE-ELIAS","sequence":"additional","affiliation":[{"name":"Transito Caceres de Allende Hospital,  Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2022]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.surg.2005.05.001","article-title":"Postoperative pancreatic fistula: an international study group (ISGPF) definition","volume":"138","author":"Bassi C","year":"2005","journal-title":"Surgery"},{"issue":"5","key":"ref2","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/SLA.0b013e31823598fb","article-title":"A prognostic score to predict major complications after pancreaticoduodenectomy","volume":"254","author":"Braga M","year":"2011","journal-title":"Ann Surg"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/hpb.12322","article-title":"Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study","volume":"17","author":"Brooke-Smith M","year":"2015","journal-title":"HPB (Oxford)"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1097\/TP.0b013e3181a6bb5e","article-title":"Hepaticoduodenostomy is an alternative to Roux-en-Y hepaticojejunostomy for biliary reconstruction in live donor liver transplantation","volume":"87","author":"Campsen J","year":"2009","journal-title":"Transplantation"},{"issue":"2","key":"ref5","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo D","year":"2004","journal-title":"Ann Surg"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.1007\/s00268-014-2698-5","article-title":"Biliary complications after pancreaticoduodenectomy: skinny bile ducts are surgeons\u2019 enemies","volume":"38","author":"Duconseil P","year":"2014","journal-title":"World J Surg"},{"key":"ref7","article-title":"Combined venous and arterial reconstruction in the triangle area after total pancreatoduodenectomy","volume":"35","author":"Fernandes ESM","year":"2022","journal-title":"ABCD Arq Bras Cir Dig"},{"issue":"1","key":"ref8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s11605-013-2336-9","article-title":"Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them? 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Arquivos Brasileiros de Cirurgia Digestiva (S\u00e3o Paulo)"],"original-title":["A SEQU\u00caNCIA ANAT\u00d4MICA DA ANASTOMOSE G\u00c1STRICA E BILIAR NA RECONSTRU\u00c7\u00c3O DA PANCREATODUODENECTOMIA \u00c9 A CAUSA DE AUMENTO DA INCID\u00caNCIA DE COLANGITE? APRESENTA\u00c7\u00c3O DE VARIANTE T\u00c9CNICA E RESULTADOS INICIAIS"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0102-67202022000100403&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T18:24:12Z","timestamp":1663352652000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0102-67202022000100403&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022]]},"references-count":24,"alternative-id":["S0102-67202022000100403"],"URL":"https:\/\/doi.org\/10.1590\/0102-672020220002e1688","relation":{},"ISSN":["2317-6326","0102-6720"],"issn-type":[{"type":"electronic","value":"2317-6326"},{"type":"print","value":"0102-6720"}],"subject":[],"published":{"date-parts":[[2022]]},"article-number":"e1688"}}