Pancreatogastrostomy with one continuous seromuscular circular suture

Abstract

Aims: Pancreatojejunostomy (PJ) and pancreatogastrostomy (PG) are the preferred methods of anastomosis after pancreatoduodenectomy (PD). We reported a new anastomosis technique using one continuous seromuscular circular suture without transpancreas sutures for submucosal PG. This study compared the frequency of pancreatic leakage, following the duct-to-mucosa PJ and the submucosal PG, respectively Methods: From January 2004 to January 2015, a comparative study between PJ and PG for patients with periampullary lesions undergoing PD was conducted. A total of 148 consecutive patients underwent PD. Among them, 116 patients underwent a duct-to-mucosa PJ and 32 underwent a submucosal PG. The pancreatic remnant was mobilized 2–3 cm from the splenic vein and the surrounding tissues. A 2 cm long seromuscular incision is made in the posterior wall of the stomach exposing the gastric mucosa. A submucosal tunnel 2 cm in length is created. A seromuscular continuous circular suture was placed around the gastric incision. The pancreatic remnant was then pulled with slide tension in the seromuscular tunnel into the stomach. Ideally, the pancreatic remnant should pass through a submucosal tunnel into the posterior gastric wall by 2–3 cm. The seromuscular continuous circular suture was tied to the lowest part of the pancreatic stump. Results: The overall mortality, morbidity and pancreatic leakage following PD were 4% (n = 6), 41.2% (n = 61) and 9.6% (n = 15), respectively. The mortality, morbidity and pancreatic leakage were 5.1% (n = 6), 44.8% (n = 52) and 11.2% (n = 13) in the PJ group, and 0%, 28.1% (n = 9) and 6.2% (n = 2) in the PG group (p < 0.05). Conclusions: Submucosal PG with continuous circular suture is a safer method than PJ, following PD at a significantly lower rate of pancreatic leakage, surgical morbidity and mortality. This technique is simple and reduces the risk of pancreatic leakage by removing the danger of suture injury of the pancreas.