Clinical application of binding pancreaticogastrostomy in the central pancreatectomy

Abstract

Objective To investigate the clinical application of binding pancreaticogastrostomy (BPG) in the central pancreatectomy (CP). Methods The clinical data of 62 patients with benign and low-grade malignant lesions in the neck and body of pancreas who received CP combined with BPG from January 2010 to October 2014 were retrospectively analyzed. Fifty-six patients with space-occupying lesions of the head and neck of pancreas were confirmed by postoperative pathological examinations, including 21 solid pseudopapillary tumors of pancreas (SPTPs), 19 pancreatic neuroendocrine neoplasms (PNENs) (13 non-functional islet cell tumors), 16 pancreatic cystic tumors (12 serous cystadenomas and 4 mucinous cystadenomas) and 6 ruptures in the head and neck of pancreas. CP combined with BPG was performed. The central pancreas was resected via upper and anterior approaches after surgical exploration, and digestive tract reconstruction was applied using BPG. The operation time, volume of intraoperative blood loss, time of postoperative gastrointestinal function recovery, drainage tube removed time, duration of hospital stay and postoperative complications were recorded. Patients were followed up by outpatient examination and telephone interview up to January 2015, and follow-up included the level of blood glucose, conditions of pancreatic exocrine function and with or without pancreatic pseudocyst. Results All the patients underwent successful operation without perioperative death. The average operation time, average volume of intraoperative blood loss, average time of postoperative gastrointestinal function recovery, average drainage tube removal time and average duration of postoperative hospital stay were 155 minutes (range, 125-230 minutes), 300 mL (range, 210-425 mL), 3.0 days (range, 2.0-5.0 days), 6.0 days (range, 4.0-10.0 days) and 10.5 days (range, 9.0-21.0 days), respectively. Seven patients with delayed gastric emptying were cured by non-surgical treatment. Of 6 patients complicated with pancreatic fistula, 4 patients (Grade A) had healed pancreatic fistulas during hospitalization, 2 patients (Grade B) with drainage tubes were discharged from hospital and then drainage tubes were removed after confirming healed pancreatic fistula by imaging examination. Of 2 patients with intraperitoneal hemorrhage, 1 underwent under gastroscope cauterisation for hemostasis and 1 underwent open reoperation for hemostasis. All the patients were followed up for 3-36 months with a median time of 25 months and without high blood glucose, pancreatic exocrine function insufficiency and pancreatic pseudocyst. Conclusions CP with the advantages of minimal invasion and quick recovery can be used as a priority surgical method for benign or low-grade malignant tumors and injures in the neck and body of pancreas. BPG is safe and feasible as well as reduce the incidence of pancreatic fistula after CP, and it is an ideal reconstruction. Key words: Pancreatic neoplasms; Pancreatic trauma; Central pancreatectomy; Binding pancreatico-gastrostomy; Pancreatic fistula