Ann Hepatobiliary Pancreat Surg.  2021 May;25(2):251-258. 10.14701/ahbps.2021.25.2.251.

Clinical outcomes and technical description of unstented end to side pancreaticogastrostomy by small posterior gastrotomy

• Bhoriwal SK
• Kumar S
• Deo S
• Sharma J
• Mishra A
• Kumar N
• Saikia J
• Dhall K

• KMID: 2516246
• DOI: http://doi.org/10.14701/ahbps.2021.25.2.251

Abstract

Backgrounds/Aims
Morbidity following Whipple’s surgery largely depends upon the pancreatic stump anastomosis leak. Pancreaticogastrostomy is one of the techniques of pancreatic stump reconstruction and is described variously in the literature. Duct to mucosa pancreaticogastrostomy is described either by a large 3-4 cm posterior gastrotomy or by small gastrotomy of 2-3 mm with the use of internal stents along with. We describe clinical outcomes and technique of 2 layer end to side pancreatico-gastrostomy by a small posterior gastrotomy without the use of internal stents.
Methods
Hospital records of 35 patients where the technique of, small posterior gastrotomy end to side duct to mucosa pancreatico-gastrostomy without internal stents, was used for pancreatic stump reconstruction were studied retrospectively. The data were analyzed for demographic details, stage of the disease, and short term outcomes related to surgical procedure.
Results
The mean duration of surgery was 7.4 hours. Grade A, B, and C POPF were observed in 10 (28.5%), 3 (8.5%), and 1 (2.8%) of patients respectively. The mean time to remove pancreatic drain was 9 days, and the mean time to start oral feeds was 8.9 days. The mean hospital stay was 12.9 days (07-26). Thirty days mortality was 2.8%.
Conclusions
Unstented duct to mucosa end to side pancreatico-gastrostomy technique is comparable with other pancreatico-gastrostomy techniques in outcomes in terms of POPF, morbidity, mortality, and hospital stay. However, to establish the superiority or inferiority of this technique, a larger study is recommended.

Keyword

Pancreatic cancer; Pancreaticoduodenectomy; Pancreatic fistula