Double purse-string telescoped pancreaticogastrostomy using an atraumatic self-retaining ring retractor following pancreaticoduodenectomy – Details of surgical procedure and early postoperative outcome

Abstract

Background: Since May 2012, pancreatico-gastrostomy (PG) using an atraumatic self-retaining ring retractor (Alexis Wound Retractor®) has been used in patients who underwent pancreaticoduodenectomy (PD) in our department. Aim: The present study shows our surgical technique with video and evaluates early postoperative outcome of our procedures. Patients and methods: Between May 2012 and December 2017, 71 patients with peri-ampullary tumors underwent PG. PG was performed as following; the anterior wall of upper stomach was incised and opened by Alexis Wound Retractor®. The remnant pancreas was inserted into the gastric cavity through the posterior wall of stomach and sutured circumferentially with running stitches to fix on the gastric muco-muscular layer. After closure of the anterior wall of stomach, purse-string sutures were tightened. Closed suction drains were placed at the site of Winslow's foramen, and both cranial and caudal sides of the PG. Pancreatic fistula (PF) was defined according to the International Study Group of Pancreatic Surgery. Results: Pancreatic cancer, extrahepatic bile duct cancer, cancer of ampulla of Vater, and other diseases were in 27, 23, 14, and 7 patients, respectively. Fifty-five patients had soft pancreatic texture. Grade BL and B/C PF were observed in 14 and 11 patients, and all patients who had Grade B/C PF had soft pancreatic texture. Serious complications associated with PF including intraabdominal hemorrhage and infectious portal vein thrombosis occurred in 4 and 2 patients. Postoperative mortality was nil. Conclusions: Early postoperative outcome of PG was acceptable. PG would be safe and easy applicable procedure.