***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospect i ve and r and omized setting . Summary Background Data : While several techniques have been proposed for reconstructing pancreatico-digestive continuity , only a limited number of r and omized studies have been carried out . Methods : A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were r and omized to receive either pancreaticogastrostomy ( group PG ) or end-to-side pancreaticojejunostomy ( group PJ ) . Results : The 2 treatment groups showed no differences in vital statistics or underlying disease , mean duration of surgery , and need for intraoperative blood transfusion . Overall , the incidence of surgical complications was 34 % ( 29 % in PG , 39 % in PJ , P = not significant ) . Patients receiving PG showed a significantly lower rate of multiple surgical complications ( P = 0.002 ) . Pancreatic fistula was the most frequent complication , occurring in 14.5 % of patients ( 13 % in PG and 16 % in PJ , P = not significant ) . Five patients in each treatment arm required a second surgical intervention ; the postoperative mortality rate was 0.6 % . PG was favored over PJ due to significant differences in postoperative collection s ( P = 0.01 ) , delayed gastric emptying ( P = 0.03 ) , and biliary fistula ( P = 0.01 ) . The mean postoperative hospitalization period stay was comparable in both groups . Conclusions : When compared with PJ , PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula . However , biliary fistula , postoperative collection s and delayed gastric emptying are significantly reduced in patients treated by PG . In addition , pancreaticogastrostomy is associated with a significantly lower frequency of multiple surgical complications OBJECTIVE Pancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy . External drainage of pancreatic duct with a stent has been shown to reduce pancreatic fistula rate of pancreaticojejunostomy in a few retrospective or prospect i ve nonr and omized studies , but no r and omized controlled trial has been reported thus far . This single-center prospect i ve r and omized trial compared the results of pancreaticoduodenectomy with external drainage stent versus no stent for pancreaticojejunal anastomosis . METHODS A total of 120 patients undergoing pancreaticoduodenectomy with end-to-side pancreaticojejunal anastomosis were r and omized to have either an external stent inserted across the anastomosis to drain the pancreatic duct ( n = 60 ) or no stent ( n = 60 ) . Duct-to-mucosa anastomosis was performed in all cases . RESULTS The 2 groups were comparable in demographic data , underlying pathologies , pancreatic consistency , and duct diameter . Stented group had a significantly lower pancreatic fistula rate compared with nonstented group ( 6.7 % vs. 20 % , P = 0.032 ) . Radiologic or surgical intervention for pancreatic fistula was required in 1 patient in the stented group and 4 patients in the nonstented group . There were no significant differences in overall morbidity ( 31.7 % vs. 38.3 % , P = 0.444 ) and hospital mortality ( 1.7 % vs. 5 % , P = 0.309 ) . Two patients in the nonstented group and none in the stented group died of pancreatic fistula . Hospital stay was significantly shorter in the stented group ( mean 17 vs. 23 days , P = 0.039 ) . On multivariate analysis , no stenting and pancreatic duct diameter <3 mm were significant risk factors of pancreatic fistula . CONCLUSION External drainage of pancreatic duct with a stent reduced leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy The effect of the long-acting somatostatin analogue S and ostatin ( SMS 201 - 995 ) on intestinal absorption and propagation ( mouth-to-caecum transit time ; MCTT ) , on pancreatic secretion and on gall bladder contraction after direct ( secretin-pancreozymin test ) and indirect stimulation ( Lundh meal ) , and on meal-induced responses of seven gastrointestinal regulatory peptides has been investigated . In a double-blind cross-over study , 9 healthy volunteers completed two 7-day periods with subcutaneous injections of either placebo or 25 micrograms SMS 201 - 995 twice daily . Mean faecal fat excretion was increased to 19.2 g/day and MCTT was three times longer during the SMS period . After duodenal infusion of a mixture containing D-galactose , D-xylose and triglycerides , SMS 201 - 995 significantly reduced the serum concentrations of D-galactose but increased serum levels of D-xylose . After 6 days of pretreatment , SMS 201 - 995 completely suppressed duodenal trypsin , lipase and bilirubin increases in response to endogenous stimulation by a Lundh meal . Concomitantly , cholecystokinin ( CCK ) release and gall bladder contraction were almost abolished . Compared with placebo , SMS 201 - 995 significantly diminished pancreatic amylase , trypsin and lipase output after stimulation with CCK , while the secretion of fluid and bicarbonate in response to secretin was unchanged . This inhibition of enzyme response was significantly more marked after a single injection of the analogue than after pretreatment for 7 days and did not reach the level of exocrine pancreatic insufficiency . CCK-induced gall bladder contraction was significantly inhibited by a single dose of 25 micrograms SMS 201 - 995 but not after 7 days of pretreatment with the somatostatin analogue Objective : This study compared the postoperative pancreatic anastomosis leakage rate of a new binding technique with the conventional technique of pancreaticojejunostomy after pancreaticoduodenectomy . Summary Background Data : Leakage from pancreatic anastomoses remains the single most important morbidity after pancreaticoduodenectomy and contributes to prolonged hospitalization and mortality . The reported incidence after conventional pancreaticojejunostomy ranged from 10 % to 29 % . We previously reported a new binding pancreaticojejunostomy technique with a leakage of 0 % . Methods : We conducted a prospect i ve r and omized study on 217 patients who underwent pancreaticoduodenectomy for benign and malignant diseases of the pancreatic head and the periampullary region comparing the 2 techniques of pancreaticojejunostomy .  Results : Of the 111 patients r and omized to the conventional group , pancreaticojejunostomy leakage occurred in 8 patients , while no patient in the 106 patients r and omized to the binding group developed leakage ( & khgr;2 test , P = 0.014 ) . The overall postoperative complications developed in 41 patients ( 36.9 % ) in the conventional group compared with 26 patients ( 24.5 % ) in the binding group ( & khgr;2 test , P = 0.048 ) . Seven patients ( 6.3 % ) died in the perioperative period in the conventional group compared with 3 patients ( 2.8 % ) in the binding group ( & khgr;2 test , P = 0.37 ) . The postoperative hospital stay ( mean ± SD ) for the conventional group was 22.4 ± 10.9 days , which was significantly longer than the binding group ( 18.4 ± 4.7 days ) ( Mann-Whitney U test , P < 0.001 ) . Conclusions : Binding pancreaticojejunostomy after panceaticoduodenectomy significantly decreased postoperative complication and pancreaticojejunostomy leakage rates and shortened hospital stay when compared with conventional pancreaticojejunostomy Previous experimental studies have shown that multiple puncturing and stitching of the pancreas results in an increased pancreatic injury response . Furthermore , post-operative pancreatitis , which still is a largely under-diagnosed condition , appears to be an important mediator of many post-operative complications after pancreatic head resection . Stenting has been suggested to improve both short-term and long-term outcome after pancreaticojejunostomy . We have recently developed a biodegradable , radiopaque self-exp and ing stent , which has experimentally been shown suitable for pancreatobiliary applications . In this pilot study we tested the new technique for pancreatico-jejunostomy in 3 patients . In this novel anastomosis technique with a biodegradable stent the pancreatic stump is first sunk into the jejunum and tightened with a purse string in the bowel serosa , without any stitches through the pancreatic tissue , and the patency of the pancreatic duct is secured with a biodegradable stent against the compression of the tightened purse-string . The creation of anastomosis was possible as planned in all 3 patients . They all recovered without complications . The stent was seen in x-ray in all 3 during hospitilization , was found to have disappeared by 1 month in 2 patients , but was still in place at 3 months in 1 patient . The initial experiences described herein encourage progression to a phase I safety study , and later possibly to a phase II r and omized trial to test the efficacy of the new method BACKGROUND The reported pancreatic anastomosis fistula rate for pancreaticoduodenectomy , distal pancreatectomy , or enucleation is 2 % to 27 % . We hypothesized that reinforcement with a vascular pedicle would decrease the number of fistulas . We report a novel technique : the use of the round ligament of the liver to reinforce the pancreatic anastomosis after resection . STUDY DESIGN Patients undergoing resection from January 1 , 2000 until August 8 , 2005 , at a tertiary referral center , were followed in a retrospective cohort study . The round ligament of the liver was disconnected from the abdominal wall , from the umbilicus to the liver . After pancreatic resection , it was sutured to the anastomosis or closure . A pancreatic fistula was defined as follows : Jackson-Pratt ( JP ) drainage>50 mL/d , after the fifth postoperative day , with amylase>3 times the serum level ; reexploration for a fistula ; postoperative pseudocyst ; or death from sepsis with a presumed fistula . RESULTS In 95 patients , we were able to mobilize the round ligament and use it as a vascular pedicle . The overall fistula rate for the series was 5.3 % ( 5 of 95 ) and for pancreaticoduodenectomy it was 8.8 % ( 5 of 57 ) . There were no fistulas within the distal pancreatectomy and enucleation group ( n=38 ) . Importantly , there was no mortality from pancreatic fistula in the studied patients and no need for operative intervention for a fistula . CONCLUSIONS We present a novel technique to prevent pancreatic fistula . Although r and omized trials are necessary , it appears that the use of the round ligament as a vascular pedicle for reinforcing the pancreatic anastomoses and resections results in a very low number of pancreatic fistulas Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy ( PD ) with encouraging results in both retrospective and prospect i ve studies . We performed a prospect i ve r and omized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD . Two hundred thirty-eight patients were r and omized to either receive a pancreatic stent ( S ) or no stent ( NS ) , and stratified according to the texture of the pancreatic remnant ( soft/normal versus hard ) . Four patients were excluded from the study ; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed . Patients who r and omized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis . In patients with a soft pancreas , 57 r and omized to the S group and 56 r and omized to the NS group . In patients with a hard pancreas , 58 r and omized to the S group and 63 r and omized to the NS group . The S and NS groups for the entire study population , as well as for the subgroup of high-risk patients with soft pancreata , were similar as regard to demographics , past medical history , preoperative symptoms , preoperative procedures , and intraoperative data . The pancreatic fistula rate for the entire study population was 9.4 % . The fistula rates in the S and NS subgroups with hard pancreata were similar , at 1.7 % and 4.8 % ( P=0.4 ) , respectively . The fistula rates in the S and NS subgroups with soft pancreata were also similar , at 21.1 % and 10.7 % ( P=0.1 ) , respectively . A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation ( e.g. , anastomotic technique , anastomotic orientation 
    Output:
    
The prophylactic use of octreotide after PD does not result in a reduced incidence of POPF .
In conclusion , our findings suggest that the successful management of pancreatic anastomoses may depend more on the meticulous surgical technique , surgical volume , and other management parameters than on the type of technique used .