Enveloped double curse-string versus conventional pancreatico-gastrostomy: comparative study

Abstract

Background: Pancreatico-gastrostomy (PG) is widely applied for restoration of connection between the distal pancreatic remnant and digestive tract. So far, comparative studies on the clinical outcome of various PG techniques are scarse. Methods: EDPS-PG entails telescoping the pancreatic remnant into the interior of the stomach via posterior gastrostomy. The telescoped pancreatic stump is encircled by two purse-string sutures which are tied in opposite directions at 180 degrees angle. The purse-string sutures are enveloped inside two layers of transfixing sutures. Results: Thirty-three patients (22 conventional PG and 11 EDPS-PG) with operable pancreatic head cancer (31) or traumatic pancreas transection (2) were enrolled. Grade C postoperative pancreatic fistula occurred only in the conventional PG group. Patients in the EDPS-PG group needed significantly shorter time before removal of the abdominal drains (p< 0.05), significantly reduced length of hospital stay (p<0.05) and significantly lower grades of postoperative complications (p< 0.05) compared with the conventional PG group. Postoperative death occurred only in one patient in the control group. No significant difference could be found regarding operative time, postoperative bleeding delayed gastric emptying or bile leak. Conclusion: EDPS is simple and safe technique for PG. EDPS-PG is associated with significant reduction in postoperative pancreatic fistula and overall complications.