with Prof. Shailesh V. Shrikhande
Pancreatoduodenectomy (PD) is widely regarded as one of the most challenging surgeries across specialties. Considerably high morbidity (25-30%) and even mortality (2-3%) is predominantly related to post operative pancreatic fistula (POPF) that may be biochemical in nature (POPF Grade A) or clinically relevant (CR-POPF grades B and C). Hence pancreatic surgeons strive for the perfect pancreatic anastomosis (PA) since PA remains the Achilles heel of PD. However, the outcome of a PA is dependent on a number of patient factors (tumor location, underlying pathology, texture of the gland, presence of associated inflammation, nutrition, fat deposition in the gland, main pancreatic duct diameter etc.) and surgeon factors (type of technique employed, surgeon experience, high volume center etc.). Since majority of patient factors cannot be modified, pancreatic surgeons continue to refine techniques and approaches in a effort to decrease the risk of POPF. This talk tries to address specific areas of a PA that should be of interest to pancreatic surgeons practicing in an era of evidence based medicine.
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