Surgical Technique for Pancreatico-enteric Anastomosis following Pancreaticoduodenectomy : A Safe and Noble Pancreaticogastrostomy with Pancreas-transfixing Method

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  • 膵頭十二指腸切除術における膵消化管吻合の手術手技 : 安全確実な膵胃密着吻合法
  • スイトウ ジュウニシチョウ セツジョジュツ ニ オケル スイショウカカン フンゴウ ノ シュジュツ シュギ : アンゼン カクジツ ナ スイイ ミッチャク フンゴウホウ

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Background and Purpose: Pancreatic anastomotic leak remains a persistent problem after pancreaticoduodenectomy. The presence of soft, nonfibrotic pancreatic tissue is one of the most important risk factors for pancreatic leak. Accordingly, we devised a pancreas-transfixing suture method for pancreaticogastrostomies in patients with a soft, nonfibrotic pancreatic remnant.

Methods: As for the pancreaticogastrostomy technique, an ultrasonically activated scalpel was used for transecting the pancreas. The inner layer involves a duct-to-mucosa anastomosis with an internal stent and the outer layer involves a single row pancreas-transfixing sutures between the pancreatic remnant and the posterior gastric wall.

Results: A total of 228 consecutive patients underwent pancreaticoduodenectomy with pancreaticogastrostomy. Of the 228 study patients, 154 patients (67%) had a soft pancreas. There was no operative or hospital death. Postoperative complications occurred in 38 patients (17%). Pancreatic fistula (Grade B/C) occurred in 4 patients (1.8%) with a soft thin pancreas. These pancreatic leaks were managed nonoperatively by maintaining the closed drains. Conclusion: This technique is simple and appears to reduce the risk of pancreatic leakage possibly by decreasing the risk of suture injury of the pancreas and by embedding the transected stump into the wall of the stomach. This novel pancreaticogastrostomy can be recommended as an effective reconstructive procedure, especially for patients with a soft, nonfibrotic pancreas.

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