<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3.dtd">
<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">surgonco</journal-id><journal-title-group><journal-title xml:lang="ru">Креативная хирургия и онкология</journal-title><trans-title-group xml:lang="en"><trans-title>Creative surgery and oncology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2076-3093</issn><issn pub-type="epub">2307-0501</issn><publisher><publisher-name>Башкирский государственный медицинский университет</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.24060/2076-3093-2025-15-3-251-258</article-id><article-id custom-type="elpub" pub-id-type="custom">surgonco-1116</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Гастростаз после гастропанкреатодуоденальной резекции: наш опыт</article-title><trans-title-group xml:lang="en"><trans-title>Delayed Gastric Emptying after Gastropancreatoduodenal Resection: Our Experience</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3531-8556</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рахимова</surname><given-names>Ф. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Rakhimova</surname><given-names>Farida S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рахимова Фарида Сулеймановна — аспирант, кафедра госпитальной хирургии</p><p>Кыргызская Республика, Бишкек</p></bio><bio xml:lang="en"><p>Farida S. Rakhimova — Postgraduate Student, Department of Hospital Surgery</p><p>Bishkek, Kyrgyz Republic</p></bio><email xlink:type="simple">farida-0209@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бебезов</surname><given-names>Б. Х.</given-names></name><name name-style="western" xml:lang="en"><surname>Bebezov</surname><given-names>Bakhadyr Kh.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бебезов Бахадыр Хакимович — д.м.н., профессор, кафедра инновационных хирургических технологий</p><p>Кыргызская Республика, Бишкек</p></bio><bio xml:lang="en"><p>Bakhadyr Kh. Bebezov — Dr. Sci. (Med.), Prof., Department of Innovative Surgical Technologies</p><p>Bishkek, Kyrgyz Republic</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0175-8385</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мамашев</surname><given-names>Н. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Mamashev</surname><given-names>Nurlan D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мамашев Нурлан Джурабаевич — к.м.н., доцент, кафедра инновационных  хирургических технологий</p><p>Кыргызская Республика, Бишкек</p></bio><bio xml:lang="en"><p>Nurlan D. Mamashev — Cand. Sci. (Med.), Assoc. Prof., Department of Innovative Surgical Technologies</p><p>Bishkek, Kyrgyz Republic</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Суров</surname><given-names>Э. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Surov</surname><given-names>Edir A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Суров Эдир Арбудуевич — к.м.н., доцент, кафедра госпитальной хирургии</p><p>Кыргызская Республика, Бишкек</p></bio><bio xml:lang="en"><p>Edir A. Surov — Cand. Sci. (Med.), Assoc. Prof., Department of Hospital Surgery</p><p>Bishkek, Kyrgyz Republic</p></bio><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Кыргызская государственная медицинская академия имени И.К. Ахунбаева</institution><country>Россия</country></aff><aff xml:lang="en"><institution>I.K. Akhunbaev Kyrgyz State Medical Academy</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Кыргызско-Российский cлавянский университет имени Б.Н. Ельцина</institution><country>Россия</country></aff><aff xml:lang="en"><institution>B.N. Yeltsin Kyrgyz-Russian Slavic University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>17</day><month>09</month><year>2025</year></pub-date><volume>15</volume><issue>3</issue><fpage>251</fpage><lpage>258</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Рахимова Ф.С., Бебезов Б.Х., Мамашев Н.Д., Суров Э.А., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Рахимова Ф.С., Бебезов Б.Х., Мамашев Н.Д., Суров Э.А.</copyright-holder><copyright-holder xml:lang="en">Rakhimova F.S., Bebezov B.K., Mamashev N.D., Surov E.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.surgonco.ru/jour/article/view/1116">https://www.surgonco.ru/jour/article/view/1116</self-uri><abstract><p>Введение. Гастропанкреатодуоденальная резекция остается единственным радикальным методом лечения злокачественных опухолей билиопанкреатодуоденальной области. Однако данное вмешательство сопровождается высокой вероятностью развития послеоперационных осложнений. Наиболее часто среди них встречается гстростаз, причины возникновения которого до настоящего времени полностью не установлены. Хотя гастростаз не является жизнеугрожающим состоянием, он существенно увеличивает продолжительность госпитализации, затраты на лечение и откладывает начало адъювантной химиотерапии. Цель исследования: оценить эффективность методов коррекции и обобщить опыт ведения пациентов с гастростазом. Материалы и методы. Исследование проведено на базе клиники имени И.К. Ахунбаева Национального госпиталя Министерства здравоохранения Кыргызской Республики в городе Бишкек. В период с 2009 по 2023 год выполнено 85 гастропанкреатодуоденальных резекций по поводу злокачественных новообразований билиопанкреатодуоденальной зоны. В исследуемой группе находились 69 мужчин и 16 женщин со средним возрастом 57,5 ± 1,4 года. Результаты. При аденокарциноме ПЖЖ в 24% случаев отмечалось развитие гастростаза, при нейроэндокринной опухоли — 75%. У больных из группы с «мягкой» ПЖЖ в 28,6% отмечалось развитие гастростаза, из группы с «плотной» ПЖЖ — 19,2% случаев. При проведении корреляции между характером паренхимы ПЖЖ и развитием гастростаза критерий достоверности составил P ≤ 0,05. Обсуждение. По результатам лечения больных с опухолями периампулярной зоны количество развившихся гастростазов составляет 23,5%. Нами были определены следующие факторы риска развития гастростаза: характер паренхимы ПЖЖ, наличие механической желтухи, гистотип опухолей, возраст пациента. Оценка у больных наличия факторов риска развития гастростаза позволит заблаговременно проводить профилактику гастростаза в послеоперационном периоде. Профилактическое применение эритромицина, согласно рекомендациям рандомизированных исследований, ускоряет разрешение гастростаза, что подтверждается клиническими результатами. Заключение. Гастропанкреатодуоденальная резекция — одна из сложнейших операций в абдоминальной хирургии не только в техническом плане, но и в послеоперационном периоде. Данная операция сопряжена с высоким риском развития послеоперационных осложнений. Выявление факторов риска поможет дать разгадку в развитии таких осложнений, как гастростаз и панкреатические фистулы.</p></abstract><trans-abstract xml:lang="en"><p>Introduction. Gastro-pancreaticoduodenal resection remains the only radical treatment of biliopancreatic and duodenal malignancies. However, this procedure is associated with a high likelihood of postoperative complications. Among them, delayed gastric emptying (DGE) is the most common, although its etiology is still unclear. While DGE is not a life-threatening condition, it significantly prolongs hospitalization, increases treatment costs, and delays the initiation of adjuvant chemotherapy. The aim of this study was to evaluate the effectiveness of treatment modalities and summarize the clinical experience of managing patients with DGE. Materials and methods. The study was conducted at the I.K. Akhunbaev Clinic of the National Hospital of the Ministry of Health of the Kyrgyz Republic, Bishkek. Between 2009 and 2023, 85 gastro-pancreaticoduodenal resections were performed for biliopancreatic and duodenal malignant neoplasms. The study group included 69 men and 16 women, with a mean age of 57.5 ± 1.4 years. Results. In patients with pancreatic adenocarcinoma, DGE developed in 24% of cases, while in those with neuroendocrine tumors, it was observed in 75% of cases. Among patients with “soft” pancreatic parenchyma, DGE occurred in 28.6%, whereas in those with “firm” parenchyma, the incidence was 19.2%. Correlation analysis between parenchymal characteristics and the development of DGE showed statistical significance (P ≤ 0.05). Discussion. In patients with tumors in the periampullary region, the overall incidence of DGE was 23.5%. The identified risk factors for DGE included pancreatic parenchymal consistency, presence of obstructive jaundice, tumor histotype, and patient age. Early recognition of these risk factors may enable preventive measures against DGE in the postoperative period. Prophylactic administration of erythromycin, as recommended by randomized trials, accelerates the resolution of DGE, which was confirmed by clinical outcomes. Conclusion. Gastro-pancreaticoduodenal resection is one of the most complex operations in abdominal surgery, both technically and postoperatively. It carries a high risk of complications. Identifying risk factors may help elucidate the mechanisms behind complications such as delayed gastric emptying and pancreatic fistulas.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>гастропанкреатодуоденальная резекция</kwd><kwd>послеоперационные осложнения</kwd><kwd>гастропарез</kwd><kwd>анастомоз хирургический</kwd><kwd>несостоятельность анастомоза</kwd><kwd>аденокарцинома поджелудочной железы</kwd><kwd>эритромицин</kwd><kwd>метокропрамид</kwd><kwd>факторы риска</kwd></kwd-group><kwd-group xml:lang="en"><kwd>gastro-pancreaticoduodenal resection</kwd><kwd>postoperative complications</kwd><kwd>delayed gastric emptying</kwd><kwd>surgical anastomosis</kwd><kwd>anastomotic leak</kwd><kwd>pancreatic adenocarcinoma</kwd><kwd>erythromycin</kwd><kwd>metoclopramide</kwd><kwd>risk factors</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Данная работа не финансировалась.</funding-statement><funding-statement xml:lang="en">This work is not funded.</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">McGuigan A., Kelly P., Turkington R.C., Jones C., Coleman H.G., McCain R.S. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2018; 24:4846–61. DOI: 10.3748/wjg.v24.i43.4846</mixed-citation><mixed-citation xml:lang="en">McGuigan A., Kelly P., Turkington R.C., Jones C., Coleman H.G., McCain R.S. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2018; 24:4846–61. DOI: 10.3748/wjg.v24.i43.4846</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Changazi S.H., Ahmed Q., Bhatti S., Siddique S., Abdul Raffay E., Farooka M.W., et al. Whipple procedure: a five-year clinical experience in Tertiary care center. Cureus. 2020;12(11):e11466. DOI: 10.7759/cureus.11466</mixed-citation><mixed-citation xml:lang="en">Changazi S.H., Ahmed Q., Bhatti S., Siddique S., Abdul Raffay E., Farooka M.W., et al. Whipple procedure: a five-year clinical experience in Tertiary care center. Cureus. 2020;12(11):e11466. DOI: 10.7759/cureus.11466</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Qiu J., Li M., Du C. Antecolic reconstruction is associated with a lower incidence of delayed gastric emptying compared to retrocolic technique after Whipple or pylorus-preserving pancreaticoduodenectomy. Medicine (Baltimore). 2019;98(34):e16663. DOI: 10.1097/MD.0000000000016663</mixed-citation><mixed-citation xml:lang="en">Qiu J., Li M., Du C. Antecolic reconstruction is associated with a lower incidence of delayed gastric emptying compared to retrocolic technique after Whipple or pylorus-preserving pancreaticoduodenectomy. Medicine (Baltimore). 2019;98(34):e16663. DOI: 10.1097/MD.0000000000016663</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Futagawa Y., Kanehira M., Furukawa K., Kitamura H., Yoshida S., Usuba T., et al. Impact of delayed gastric emptying after pancreaticoduodenectomy on survival. J Hepatobiliary Pancreat Sci. 2017;24(8):466–74. DOI: 10.1002/jhbp.482</mixed-citation><mixed-citation xml:lang="en">Futagawa Y., Kanehira M., Furukawa K., Kitamura H., Yoshida S., Usuba T., et al. Impact of delayed gastric emptying after pancreaticoduodenectomy on survival. J Hepatobiliary Pancreat Sci. 2017;24(8):466–74. DOI: 10.1002/jhbp.482</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Varghese C., Bhat S., Wang T.H., O’Grady G., Pandana boyana S. Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials. BJS Open. 2021;5(3):zrab035. DOI: 10.1093/bjsopen/zrab035</mixed-citation><mixed-citation xml:lang="en">Varghese C., Bhat S., Wang T.H., O’Grady G., Pandana boyana S. Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials. BJS Open. 2021;5(3):zrab035. DOI: 10.1093/bjsopen/zrab035</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Müller P.C., Ruzza C., Kuemmerli C., Steinemann D.C., Müller S.A., Kessler U., et al. 4/5 gastrectomy in patients undergoing pancreaticoduodenectomy reduces delayed gastric emptying. J Surg Res. 2020;249:180–5. DOI: 10.1016/j.jss.2019.12.028</mixed-citation><mixed-citation xml:lang="en">Müller P.C., Ruzza C., Kuemmerli C., Steinemann D.C., Müller S.A., Kessler U., et al. 4/5 gastrectomy in patients undergoing pancreaticoduodenectomy reduces delayed gastric emptying. J Surg Res. 2020;249:180–5. DOI: 10.1016/j.jss.2019.12.028</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Klaiber U., Probst P., Strobel O., Michalski C.W., Dörr- Harim C., Diener M.K., et al. Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy. Br J Surg. 2018;105(4):339–49. DOI: 10.1002/bjs.10771</mixed-citation><mixed-citation xml:lang="en">Klaiber U., Probst P., Strobel O., Michalski C.W., Dörr- Harim C., Diener M.K., et al. Meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy. Br J Surg. 2018;105(4):339–49. DOI: 10.1002/bjs.10771</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Bell R., Pandanaboyana S., Shah N., Bartlett A., Windsor J.A., Smith A.M. Meta-analysis of antecolic versus retrocolic gastric reconstruction after a pylorus-preserving pancreatoduodenectomy. HPB (Oxford). 2015;17(3):202–8. DOI: 10.1111/hpb.12344</mixed-citation><mixed-citation xml:lang="en">Bell R., Pandanaboyana S., Shah N., Bartlett A., Windsor J.A., Smith A.M. Meta-analysis of antecolic versus retrocolic gastric reconstruction after a pylorus-preserving pancreatoduodenectomy. HPB (Oxford). 2015;17(3):202–8. DOI: 10.1111/hpb.12344</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Zhou Y., Hu B., Wei K., Si X. Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis. BMC Gastroenterol. 2018;18(1):176. DOI: 10.1186/s12876-018-0909-5</mixed-citation><mixed-citation xml:lang="en">Zhou Y., Hu B., Wei K., Si X. Braun anastomosis lowers the incidence of delayed gastric emptying following pancreaticoduodenectomy: a meta-analysis. BMC Gastroenterol. 2018;18(1):176. DOI: 10.1186/s12876-018-0909-5</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Hwang H.K., Lee S.H., Han D.H., Choi S.H., Kang C.M., Lee W.J. Impact of Braun anastomosis on reducing delayed gastric emptying following pancreaticoduodenectomy: a prospective, randomized controlled trial. J Hepatobiliary Pancreat Sci. 2016;23(6):364–72. DOI: 10.1002/jhbp.349</mixed-citation><mixed-citation xml:lang="en">Hwang H.K., Lee S.H., Han D.H., Choi S.H., Kang C.M., Lee W.J. Impact of Braun anastomosis on reducing delayed gastric emptying following pancreaticoduodenectomy: a prospective, randomized controlled trial. J Hepatobiliary Pancreat Sci. 2016;23(6):364–72. DOI: 10.1002/jhbp.349</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Fujieda H., Yokoyama Y., Hirata A., Usui H., Sakatoku Y., Fukaya M., et al. Does Braun anastomosis have an impact on the incidence of delayed gastric emptying and the extent of intragastric bile reflux following pancreatoduodenectomy? — A randomized controlled study. Dig Surg. 2017;34(6):462–8. DOI: 10.1159/000455334</mixed-citation><mixed-citation xml:lang="en">Fujieda H., Yokoyama Y., Hirata A., Usui H., Sakatoku Y., Fukaya M., et al. Does Braun anastomosis have an impact on the incidence of delayed gastric emptying and the extent of intragastric bile reflux following pancreatoduodenectomy? — A randomized controlled study. Dig Surg. 2017;34(6):462–8. DOI: 10.1159/000455334</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Xiao Y., Hao X., Yang Q., Li M., Wen J., Jiang C. Effect of BillrothII versus Roux-en-Y reconstruction for gastrojejunostomy after pancreaticoduodenectomy on delayed gastric emptying: a metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2021;28(5):397–408. DOI: 10.1002/jhbp.828</mixed-citation><mixed-citation xml:lang="en">Xiao Y., Hao X., Yang Q., Li M., Wen J., Jiang C. Effect of BillrothII versus Roux-en-Y reconstruction for gastrojejunostomy after pancreaticoduodenectomy on delayed gastric emptying: a metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2021;28(5):397–408. DOI: 10.1002/jhbp.828</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Busquets J., Martín S., Fabregat J., Secanella L., Pelaez N., Ramos E. Randomized trial of two types of gastrojejuno stomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial). Br J Surg. 2019;106(1):46–54. DOI: 10.1002/bjs.11023</mixed-citation><mixed-citation xml:lang="en">Busquets J., Martín S., Fabregat J., Secanella L., Pelaez N., Ramos E. Randomized trial of two types of gastrojejuno stomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial). Br J Surg. 2019;106(1):46–54. DOI: 10.1002/bjs.11023</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Herrera Cabezón J., Sánchez Acedo P., TarifaCastilla A., ZazpeRipa C. Delayed gastric emptying following pancreatoduodenectomy: a Rouxen-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study. Rev Esp Enferm Dig. 2019;111(1):34–9. DOI: 10.17235/reed.2018.5744/2018</mixed-citation><mixed-citation xml:lang="en">Herrera Cabezón J., Sánchez Acedo P., TarifaCastilla A., ZazpeRipa C. Delayed gastric emptying following pancreatoduodenectomy: a Rouxen-Y gastrojejunostomy vs Billroth II gastrojejunostomy randomized study. Rev Esp Enferm Dig. 2019;111(1):34–9. DOI: 10.17235/reed.2018.5744/2018</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Hayama S., Senmaru N., Hirano S. Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy. BMC Surg. 2020;20(1):60. DOI: 10.1186/s12893-020-00707-w</mixed-citation><mixed-citation xml:lang="en">Hayama S., Senmaru N., Hirano S. Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy. BMC Surg. 2020;20(1):60. DOI: 10.1186/s12893-020-00707-w</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Jin Y., Feng Y.Y., Qi X.G., Hao G., Yu Y.Q., Li J.T., et al. Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: an updated meta-analysis of RCTs and our experience. World J Gastrointest Surg. 2019;11(7):322–32. DOI: 10.4240/wjgs.v11.i7.322</mixed-citation><mixed-citation xml:lang="en">Jin Y., Feng Y.Y., Qi X.G., Hao G., Yu Y.Q., Li J.T., et al. Pancreatogastrostomy vs pancreatojejunostomy after pancreaticoduodenectomy: an updated meta-analysis of RCTs and our experience. World J Gastrointest Surg. 2019;11(7):322–32. DOI: 10.4240/wjgs.v11.i7.322</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">van Hilst J., de Rooij T., Bosscha K., Brinkman D.J., van Dieren S., Dijkgraaf M.G., et al. Dutch Pancreatic Cancer Group. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol. 2019;4(3):199–207. DOI: 10.1016/S2468-1253(19)30004-4</mixed-citation><mixed-citation xml:lang="en">van Hilst J., de Rooij T., Bosscha K., Brinkman D.J., van Dieren S., Dijkgraaf M.G., et al. Dutch Pancreatic Cancer Group. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol. 2019;4(3):199–207. DOI: 10.1016/S2468-1253(19)30004-4</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Poves I., Burdío F., Morató O., Iglesias M., Radosevic A., Ilzarbe L., et al. Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Ann Surg. 2018;268(5):731–9. DOI: 10.1097/SLA.0000000000002893</mixed-citation><mixed-citation xml:lang="en">Poves I., Burdío F., Morató O., Iglesias M., Radosevic A., Ilzarbe L., et al. Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Ann Surg. 2018;268(5):731–9. DOI: 10.1097/SLA.0000000000002893</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">Zhang H., Lan X., Peng B., Li B. Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis. World J Gastroenterol. 2019;25(37):5711–31. DOI: 10.3748/wjg.v25.i37.5711</mixed-citation><mixed-citation xml:lang="en">Zhang H., Lan X., Peng B., Li B. Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis. World J Gastroenterol. 2019;25(37):5711–31. DOI: 10.3748/wjg.v25.i37.5711</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Ausania F., Landi F., Martínez-Pérez A., Fondevila C. A meta-analysis of randomized controlled trials comparing laparoscopic vs open pancreaticoduodenectomy. HPB (Oxford). 2019;21(12):1613–20. DOI: 10.1016/j.hpb.2019.05.017</mixed-citation><mixed-citation xml:lang="en">Ausania F., Landi F., Martínez-Pérez A., Fondevila C. A meta-analysis of randomized controlled trials comparing laparoscopic vs open pancreaticoduodenectomy. HPB (Oxford). 2019;21(12):1613–20. DOI: 10.1016/j.hpb.2019.05.017</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Lin D., Yu Z., Chen X., Chen W., Zou Y., Hu J. Laparoscopic versus open pancreatoduodenectomy: a meta-analysis of randomized controlled trials. Rev Esp Enferm Dig. 2020;112(1):34–40. DOI: 10.17235/reed.2019.6343/2019</mixed-citation><mixed-citation xml:lang="en">Lin D., Yu Z., Chen X., Chen W., Zou Y., Hu J. Laparoscopic versus open pancreatoduodenectomy: a meta-analysis of randomized controlled trials. Rev Esp Enferm Dig. 2020;112(1):34–40. DOI: 10.17235/reed.2019.6343/2019</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
