Toward improving uniformity and standardization in the reporting of pancreatic anastomoses: A new classification system by the International Study Group of Pancreatic Surgery (ISGPS)

Accepted 9 September 2009. published online 02 November 2009.

Background

To date, there is no uniform and standardized manner of defining pancreatic anastomoses after pancreatic resection.

Methods

A systematic search was performed to determine the various factors, either related to the pancreatic remnant after pancreatic resection or to types of pancreatoenteric anastomoses that have been shown to influence failure rates of pancreatic anastomoses.

Results

Based on the data obtained, we formulated a new classification that incorporates factors related to the pancreatic remnant, such as pancreatic duct size, length of mobilization, and gland texture, as well as factors related to the pancreatoenteric anastomosis, such as the use of pancreatojejunostomy/pancreatogastrostomy; duct-to-mucosa anastomosis; invagination (dunking) of the remnant into the jejunum or stomach; and the use of a stent (internal or external) across the anastomosis.

Conclusion

By creating a standardized classification for recording and reporting of the pancreatoenterostomy, future publications would allow a more objective comparison of outcomes after pancreatic surgery. In addition, use of such a classification might encourage studies evaluating outcomes after specific types of anastomoses in certain clinical situations that could lead to the formulation of best practice guidelines of anastomotic techniques for a particular combination of findings in the pancreatic remnant.

a Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India

b Department of Gastrointestinal Surgery, Centre Hospitalier Intercommunal, Poissy, France and the Department of Surgery, University of Athens, Hippokration Hospital, Athens, Greece

c Department of Surgical and Gastroenterological Sciences Hospital G. B. Rossi, University of Verona, Verona, Italy

d Department of Surgery, University of Heidelberg, Heidelberg, Germany

e First Department of Surgery, Agia Olga Hospital, Athens, Greece

f Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

g Department of General, Visceral and Thoracic Surgery, University of Hamburg, Hamburg, Germany

h Division of Surgery and Oncology, Royal University Liverpool Hospital, Liverpool, UK

i Department of Surgery and Specialty Services, Flinders Medical Centre, Flinders, South Australia

j Gastroenterology Research Unit, Mayo Clinic, Rochester, MN

k Department of General, Vascular and Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA

l Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA

Reprint requests: Parul J. Shukla, MS, FRCS, Associate Professor and Consultant Surgeon, Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai 400 012, India.

PII: S0039-6060(09)00527-3

doi:10.1016/j.surg.2009.09.003

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