Open Access Review Article Int J Surg Med. 2015; 1(1): 2-6 doi: 10.5455/ijsm.20150411090731



PANCREATOGASTROSTOMY WITH ONE CONTINUOUS SEROMUSCULAR CIRCULAR SUTURE Daniel Vasilev Kostov, Georgi Kobakov, Daniel Yankov. Abstract

Objective: One of the most feared complications after pancreaticoduodenectomy (PD) remains postoperative pancreatic fistula (POPF). In the current study, we demonstrate a new technique for pancreaticogastrostomy (PG), using one continuous seromuscular circular suture without trans pancreas sutures for PG.

Material and Methods: During the period December 2012 to December 2014, 32 consecutive patients underwent PD (either pylorus-preserving or classical Whipple’s) carried out using the above suture-less PG. Indication for PD was pancreatic duct carcinoma. Procedures were carried out by the same surgeon, same approach and anastomotic method in order to avoid technical changes.

Results: Postoperative mortality was zero and morbidity was 21.8% (n=7). Pancreatic leakage (Grade A/B) occurred in 2 (6.2%) patients. These pancreatic leaks were managed nonoperative by maintaining the closed drains. The most common postoperative complication delayed gastric emptying (Grade B/C) in 3 (9.3%) patients.

Conclusion: We conclude that the suture-less PG possesses several advantages over conventional PG and pancreaticojejunostomy (PJ). This technic seems to lessen the risk of a pancreatic leak, probably by diminishing the possibility of suture damage to the pancreas and by embedding the transected stump into the posterior gastric wall. This novel PG is a valid and valuable procedure, especially for soft, nonfibrotic pancreas. Key words: Pancreaticoduodenectomy; Pancreaticogastrostomy; Suture-less pancreaticogastrostomy; Postoperative pancreatic fistula Pancreaticoduodenectomy; Pancreaticogastrostomy; Suture-less pancreaticogastrostomy; Postoperative pancreatic fistula

