Table 2.
Utilization of operative strategies for pancreatoenteric reconstruction, stratified by region
| Variable | Asia/Australia | Europe/Africa/ Middle East | North America | South/Central America | Overall | P-value |
|---|---|---|---|---|---|---|
| Surgeons, n (%) | 209 (23.5%) | 273 (30.6%) | 282 (31.6%) | 127 (14.3) | 891# | – |
| Preferred anastomotic reconstruction | ||||||
| Pancreatojejunostomy | 185 (88.5%) | 221 (81.0%) | 268 (96.4%) | 111 (88.8%) | 785 (88.7%) | <0.001a |
| End-to-side duct-to-mucosa | 133 (63.6%) | 169 (61.9%) | 220 (79.1%) | 76 (60.8%) | 598 (67.6%) | |
| End-to-side invagination/dunking | 32 (15.3%) | 35 (12.8%) | 29 (10.4%) | 10 (8.0%) | 106 (12.0%) | |
| End-to-end invagination/dunking | 15 (7.2%) | 7 (2.6%) | 17 (6.1%) | 20 (16.0%) | 59 (6.7%) | |
| End-to-end binding | 5 (2.4%) | 10 (3.7%) | 2 (0.7%) | 5 (4.0%) | 22 (2.5%) | |
| Pancreatogastrostomy | 21 (10.0%) | 45 (16.5%) | 9 (3.2%) | 11 (8.8%) | 86 (9.7%) | |
| Duct-to-mucosa | 7 (3.3%) | 7 (2.6%) | 2 (0.7%) | 5 (4.0%) | 21 (2.4%) | |
| Invagination/dunking | 14 (6.7%) | 38 (13.9%) | 7 (2.5%) | 6 (4.8%) | 65 (7.3%) | |
| No reconstruction (ductal occlusion) | 0 | 2 (0.7%) | 1 (0.4%) | 0 | 3 (0.3%) | |
| Other | 3 (1.4%) | 5 (1.8%) | 0 | 3 (2.4%) | 11 (1.2%) | |
| Same type of pancreatoenteric reconstruction on every case | ||||||
| No – variable according to the circumstance of the case | 66 (31.6%) | 110 (40.4%) | 87 (31.3%) | 53 (42.1%) | 316 (35.7%) | 0.032 |
| Yes – same technique every time | 143 (68.4%) | 162 (59.6%) | 191 (68.7%) | 73 (57.9%) | 569 (64.3%) | |
| Suture technique | ||||||
| Single layer | 48 (23.1%) | 104 (38.1%) | 30 (10.8%) | 36 (28.6%) | 218 (24.6%) | <0.001 |
| Double layer | 160 (76.9%) | 169 (61.9%) | 249 (89.2%) | 90 (71.4%) | 668 (75.4%) | |
| Suture type – if inner layer (duct-to-mucosa) | ||||||
| Absorbable monofilament (e.g. PDS, Maxon, Monocryl) | 154 (75.5%) | 176 (68.5%) | 221 (79.5%) | 75 (59.5%) | 626 (72.4%) | <0.001 |
| Absorbable braided (e.g. vicryl) | 16 (7.8%) | 13 (5.1%) | 28 (10.1%) | 16 (12.7%) | 73 (8.4%) | |
| Non-absorbable braided (e.g. silk, polyester) | 8 (3.9%) | 24 (9.3%) | 5 (1.8%) | 8 (6.3%) | 45 (5.2%) | |
| Other (e.g. catgut, chromic) | 6 (2.9%) | 5 (1.9%) | 12 (4.3%) | 15 (11.9%) | 38 (4.4%) | |
| Do not perform an inner layer | 20 (9.8%) | 39 (15.2%) | 12 (4.3%) | 12 (9.5%) | 83 (9.6%) | |
| Suture type – if outer layer (pancreatic capsule-to-bowel) | ||||||
| Absorbable monofilament (e.g. PDS, Maxon, Monocryl) | 97 (46.9%) | 136 (50.6%) | 47 (17.0%) | 40 (31.5%) | 320 (36.4%) | <0.001 |
| Absorbable braided (e.g. vicryl) | 14 (6.8%) | 24 (8.9%) | 33 (12.0%) | 27 (21.3%) | 98 (11.1%) | |
| Non-absorbable braided (e.g. silk, polyester) | 69 (33.3%) | 80 (29.7%) | 178 (64.5%) | 31 (24.4%) | 358 (40.7%) | |
| Other (e.g. catgut, chromic) | 21 (10.1%) | 10 (3.7%) | 13 (4.7%) | 27 (21.3%) | 71 (8.1%) | |
| I do not perform an outer layer | 6 (2.9%) | 19 (7.1%) | 5 (1.8%) | 2 (1.6%) | 32 (3.6%) | |
| Pancreatogastrostomy | ||||||
| Never | 128 (61.8%) | 150 (56.2%) | 185 (66.5%) | 88 (69.8%) | 551 (62.8%) | 0.001 |
| Occasionally (1–25%) | 52 (25.1%) | 65 (24.3%) | 77 (27.7%) | 28 (22.2%) | 222 (25.3%) | |
| Sometimes (26–75%) | 9 (4.3%) | 14 (5.2%) | 8 (2.9%) | 2 (1.6%) | 33 (3.8%) | |
| Frequently (76–99%) | 12 (5.8%) | 22 (8.2%) | 4 (1.4%) | 3 (2.4%) | 41 (4.7%) | |
| Always | 6 (2.9%) | 16 (6.0%) | 4 (1.4%) | 5 (4.0%) | 31 (3.5%) | |
| Dunking or invagination | ||||||
| Never | 86 (41.7%) | 107 (39.9%) | 94 (33.9%) | 40 (32.5%) | 327 (37.4%) | 0.034 |
| Occasionally (1–25%) | 55 (26.7%) | 80 (29.9%) | 117 (42.2%) | 41 (33.3%) | 293 (33.5%) | |
| Sometimes (26–75%) | 10 (4.9%) | 8 (3.0%) | 14 (5.1%) | 8 (6.5%) | 40 (4.6%) | |
| Frequently (76–99%) | 32 (15.5%) | 42 (15.7%) | 27 (9.7%) | 21 (17.1%) | 122 (14.0%) | |
| Always | 23 (11.2%) | 31 (11.6%) | 25 (9.0%) | 13 (10.6%) | 92 (10.5%) | |
| Duct occlusion | ||||||
| Never | 192 (93.7%) | 231 (88.5%) | 255 (92.7%) | 113 (91.9%) | 791 (91.6%) | 0.068 |
| Occasionally (1–25%) | 8 (3.9%) | 26 (10.0%) | 20 (7.3%) | 6 (4.9%) | 60 (6.9%) | |
| Sometimes (26–75%) | 3 (1.5%) | 1 (0.4%) | 0 | 3 (2.4%) | 7 (0.8%) | |
| Frequently (76–99%) | 1 (0.5%) | 2 (0.8%) | 0 | 0 | 3 (0.3%) | |
| Always | 1 (0.5%) | 1 (0.4%) | 0 | 1 (0.8%) | 3 (0.3%) | |
| Isolated Roux limb | ||||||
| Never | 152 (74.5%) | 166 (62.6%) | 227 (81.7%) | 49 (39.2%) | 594 (68.1%) | <0.001 |
| Occasionally (1–25%) | 31 (15.2%) | 57 (21.5%) | 37 (13.3%) | 31 (24.8%) | 156 (17.9%) | |
| Sometimes (26–75%) | 4 (2.0%) | 10 (3.8%) | 3 (1.1%) | 7 (5.6%) | 24 (2.8%) | |
| Frequently (76–99%) | 9 (4.4%) | 9 (3.4%) | 6 (2.2%) | 17 (13.6%) | 41 (4.7%) | |
| Always | 8 (3.9%) | 23 (8.7%) | 5 (1.8%) | 21 (16.8%) | 57 (6.5%) | |
a
P < 0.001 even when comparing the condensed categorization of pancreatojejunostomy, pancreatogastrostomy, no reconstruction, and other.
#
Six surgeons did not indicate their region