HPB Virtual Journal Club: September 2015

The rapid rise in quality and quantity of manuscripts submitted to HPB means that the editorial team now have a wealth of high quality papers to choose from when compiling the virtual journal club (VJC). It is now possible to provide several articles on potentially controversial issues thus hopefully generating a VJC that stimulates discussion and potentially changes practice.

The latest VJC focuses on the pancreatic anastomosis. There have been several recent important publications on this topic in HPB and the editorial team are delighted to be able to bring them together for this VJC.

The first paper by Addeo et al sets the scene with regard to the morbidity of post operative pancreatic fistula (POPF) and illustrates why it is important that pancreatic surgeons strive to reduce the incidence of POPF by ensuring optimal technique and perioperative care of patients undergoing pancreaticoduodenectomy.  The following three papers focus on technical issues with El Nakeeb et al describing the outcomes of an isolated roux limb for the pancreatic reconstruction while Liu et al provide a systematic review comparing the outcomes of pancreaticogastrostomy (PG) vs. pancreaticojejunostomy (PJ). The third paper (available on early view shortly), by Shyr et al, focusing on technique is a single centre study comparing a modified Blumgart PJ to PG.

The editorial team have deliberately selected papers to stimulate discussion and challenge readers to think about why these studies seem to come to diametric conclusions. This leads onto what surely will be the definitive paper regarding the use of octreotide by McMillian et al highlighting the potential harm particularly in those patients at high risk of POPF. Throughout these papers astute readers will have detected the importance of stratifying patients by risk of POPF. Surely the fistula risk score will now become mandatory for all papers discussing POPF. Early detection of POPF and the use of serum amylase on post operative day 0 is highlighted by Lavanniya et al, while how to manage a clinically relevant POPF is discussed in detail by Balazano et al.

To conclude the VJC, a link to a video by Jayaraman eloquently demonstrating how to perform a laparoscopic Blumgart PJ is presented. The clear explanation of the steps and technical modifications required to successfully complete the anastomosis laparoscopically are highlighted and this video is a must for those who would like to have this as part of their armamentarium.

Click here for the September VJC

Click here for all past VJCs

Why not share your thoughts on the myHPB discussion board?

Published on Wednesday 23rd September 2015