Background: s/Aims: Postoperative pancreatic fistula (POPF) remains a significant complication following pancreatoduodenectomy (PD). It has been hypothesized that single loop (SL) reconstruction may increase the risk of POPF, leading to the proposal of double-loop (DL) reconstruction. In this approach, the pancreatic duct is connected to an isolated loop of bowel in a Roux-en-Y configuration. Methods: We conducted a retrospective multicenter study to compare various types of reconstruction after PD, analyzing data from 1,502 patients who underwent open, laparoscopic, or robotic PD across 28 centers worldwide. Propensity score matching (PSM) was applied to enhance comparability. Results: The overall rate of POPF was 34.89%, with a grade C POPF rate of 4.26%. The type of reconstruction (SL vs. DL) did not significantly impact the rates of POPF or grade C POPF, both before and after PSM. The rate of delayed gastric emptying (DGE) was 20.71%, and patients with DL reconstruction had a lower incidence of DGE both before and after PSM. Conclusions Our study found no significant differences in the risk of POPF between SL and DL reconstruction. However, DL reconstruction is associated with a reduced risk of DGE, suggesting it may be a preferable option following open PD.

Background: and Purpose In patients with ischemic stroke and isolated cervical internal carotid artery occlusion (c-ICA-O), endovascular therapy (EVT) can improve cerebral perfusion. To maintain vessel patency, EVT is frequently combined with carotid artery stenting (CAS). We assessed the efficacy and safety of emergent CAS during EVT for isolated c-ICA-O. Methods: This retrospective multinational cohort study (42 centers) included consecutive patients who underwent EVT for isolated c-ICA-O within 24 hours from the time last seen well. Patients who underwent emergent CAS were compared with those who did not. Co-primary outcomes were c-ICA vessel patency and symptomatic intracerebral hemorrhage (sICH) 24 hours post-EVT. Secondary outcomes included any intracerebral hemorrhage (ICH) at 24 hours and disability at 3 months (modified Rankin Scale [mRS] shift). Outcomes were adjusted using inverse probability of treatment weighting. Results: Of 317 patients (mean age, 68.6 years [standard deviation, 12.9]; median National Institutes of Health Stroke Scale 11 [interquartile range, 6–17]; 26.8% female), 219 (69.1%) underwent CAS, whereas 98 (30.9%) did not. At 24 hours, vessel patency was more common after CAS (83.5% vs. 40.7%; adjusted odds ratio [aOR], 9.45; 95% confidence interval [CI], 4.91–18.17); sICH rates did not differ (2.3% vs. 3.1%; aOR, 0.92; 95% CI, 0.18–4.73). Any ICH was more common after CAS (19.3% vs. 9.3%; aOR, 2.50; 95% CI, 1.12–5.60). CAS was not associated with mRS at 3 months (adjusted common odds ratio, 0.98; 95% CI, 0.62–1.56). Conclusions In patients undergoing EVT for isolated c-ICA-O, emergent CAS was technically effective and reasonably safe. More frequent vessel patency in patients who underwent CAS did not translate into improved functional outcome at 3 months.