Binding Pancreaticogastrostomy Research Articles

Binding pancreaticogastrostomy after pancreaticoduodenectomy and central pancreatectomy

AbstractObjectiveThe pancreatic fistula rate is high when pancreaticojejunostomy is performed in patients with soft pancreas, narrow pancreatic duct, major intraoperative bleeding and pathology of the resected pancreas other than pancreatic cancer and pancreatitis. Binding pancreaticogastrostomy (BPG) was proposed to reduce pancreatic fistula. This study aims at evaluation of BPG in prevention of pancreatic fistula.MethodsOne hundred and thirteen patients had BPG after pancreaticoduodenectomy (n = 105) or central pancreatectomy (n = 8). The BPG consisted of two purse string sutures around the pancreas stump and inner anchoring within the stomach and without suturing of the pancreas outside the stomach. The patients were categorised as negligible risk, low risk, intermediate risk and high risk of developing pancreatic fistula according to the presence of risks factors such as pancreas texture, size of pancreatic duct, volume of intraoperative bleeding and pathology of the resected pancreas. Pancreatic fistula of Grade B and C were considered as clinically relevant pancreatic fistulas (CRPF).ResultsPatients with negligible and low risk did not have pancreatic fistula. Three (6%) of 50 patients with intermediate risk and four (8.6%) of 46 patients with high risk developed CRPF (Grade B, 3 patients; Grade C, 4 patients). The overall CRPF rate was 6.2%. Non‐fistulous complication rate was 14.2%.ConclusionBPG is a feasible alternative to pancreaticojejunostomy for patients with high risk of developing pancreatic fistula.

Modified binding pancreaticogastrostomy vs modified Blumgart pancreaticojejunostomy after laparoscopic pancreaticoduodenectomy for pancreatic or periampullary tumors.

BACKGROUNDLaparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy (PD), especially during the learning curve. Despite multiple randomized controlled trials and meta-analyses, the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is debatable. Also, the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.AIMTo compare the short-term outcomes of modified binding pancreaticogastrostomy (PG) and Blumgart pancreaticojejunostomy (PJ) during learning curve of laparoscopic PD.METHODSThe first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve. A single layer of the full-thickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG. In the modified Blumgart technique, only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct (total two sutures) to secure the pancreatic parenchyma to the jejunum. Also, on the ventral surface, the knot is tied on the jejunal wall without going through the pancreatic parenchyma. Post pancreatectomy complications are graded as per the International Study Group for Pancreatic Surgery criteria.RESULTSDuring the study period, modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 patients. The demographic and clinical parameters of the first 25 patients included in both groups were comparable. Lower end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups (32/50, 64%). The median operative time for pancreatic reconstruction was significantly lower in the binding PG group (42 vs 58 min, P = 0.01). The clinically relevant (Grade B/C) postoperative pancreatic fistula (POPF) was significantly more in the modified PJ group (28% vs 4%, P = 0.04). In contrast, intraluminal postpancreatectomy hemorrhage (PPH) was more in the binding PG group (32% vs 4%, P = 0.02). There was no significant difference in the incidence of delayed gastric emptying between the two groups.CONCLUSIONDuring the learning curve of laparoscopic PD, modified binding PG reduces POPF but is associated with increased intraluminal PPH compared to PJ using the modified Blumgart technique.

The Effect of Braun’s Enteroenterostomy on Delayed Gastric Emptying in Binding Pancreaticogastrostomy Following Pancreaticoduodenectomy: a Comparative Study and Review of Literature

The Effect of Braun’s Enteroenterostomy on Delayed Gastric Emptying in Binding Pancreaticogastrostomy Following Pancreaticoduodenectomy: a Comparative Study and Review of Literature

Initial Experience with a New Technique of Binding Pancreaticogastrostomy: A Prospective Study

Aim To study postoperative complications in patients undergoing binding pancreaticogastrostomy (PG) following pancreaticoduodenectomy (PD) in a tertiary hospital in India.

Conventional pancreticojejunostomy versus suture-less binding pancreaticogastrostomy- a single institution single surgeon comparitive study

Conventional pancreticojejunostomy versus suture-less binding pancreaticogastrostomy- a single institution single surgeon comparitive study

A study on outcome of binding pancreaticogastrostomy following pancreaticoduodenectomy: A prospective observational study

IntroductionThe type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy. Aims and objectivesThe aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications. Materials and methodsThe study included all patients who had undergone binding pancreaticogastrostomy from Mar 2012 to Mar 2016 at a tertiary care hospital. Patients' data, including patients demographics, type of procedure performed, complications, mortality, hospital stay, postoperative interventional procedures or reoperations were all documented. ResultsThere were 60 men and 37 women (mean age was 55.4 ± 11.6 years) with a mean BMI of 22.6 Kg/M2. 16% of the patients had evidence of cholangitis and 14 of them had to be stented preoperatively. Ninety-four percent of the patients were operated for malignant cause of obstructive jaundice. The mean operative time was 283 min s and average blood loss during surgery was 352 ml. 36% of the patients were operated by the senior residents undergoing training in Gastro intestinal surgery with the assistance of the available faculty. 60% of the patients had a pancreatic duct diameter less than 3 mm. 72% of the pancreatic stump were soft in consistency. In our study we had 3% patients with pancreatic leak. The most frequent complication was DGE, which was seen in 22% patients. The mean duration of DGE was 13.5 ± 2.6 days. We had 2 deaths within 30 days of surgery of which one was due to massive intraabdominal bleed due to pancreatic leak. None of the parameters like pre-operative and operative parameters like age, bilirubin, total leucocyte count, preoperative stenting, pancreatic duct diameter, texture of pancreas and surgery performed by residents were found to be responsible for pancreatic leak. ConclusionThis novel method of binding PG is simple, secure, and reproducible. It possesses several advantages over the conventional PG: it is very easy to perform, it is less traumatic to the pancreatic stump, can be performed in all types of pancreatic stump irrespective of the texture and diameter of the pancreatic duct without any statistically significant adverse outcomes.

Binding pancreaticogastrostomy anastomosis in central pancreatectomy: A single center experience.

A growing number of central pancreatectomies are performed. However, reconstruction of pancreaticoenteral digestive continuity after central pancreatectomy remains debated. This study evaluates the short-term outcomes of binding pancreaticogastrostomy anastomosis in central pancreatectomy.We have reviewed our experience with 52 patients who underwent binding pancreaticogastrostomy following central pancreatectomy from February 2009 to March 2015. Indication includes 6 noninvasive intraductal papillary mucinous neoplasms, 11 neuroendocrine tumors, 12 solid pseudopapillary tumor, 9 serous cystadenoma, 6 mucinous cystadenoma, and 8 focal pancreatic traumas.The mortality rate was nil while the morbidity rate was 34.6%. Eighteen patients experienced complications including 6 pancreatic fistulas, 2 postpancreatectomy hemorrhages, 4 delayed gastric emptying, 1 hypostatic pneumonia, and 5 pancreatitis. The median postoperative length of hospital stay was 12 days (10 days for patients without fistula). None of the 52 patients were found to have pancreatic endocrine or exocrine insufficiency or recurrence of tumors.Central pancreatectomy with binding pancreaticogastrostomy is a useful and practicable surgical procedure for benign or borderline lesions of the pancreatic neck or proximal body.

A 50-case consecutive experience of Peng's binding pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy

Purpose: To overcome the high morbidity rate associated with postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy, new pancreatic anastomosis techniques have been developed, including Peng's binding pancreaticogastrostomy (BPG). We present our 50-case experience with Peng's BPG. Methods: From October 2011 to April 2014, 50 consecutive cases of PPPD with BPG were performed. All clinical data were collected prospectively. Short-term outcomes pancreatic fistula-related complications were analyzed. Results: Of the 50 cases, 42 (84%) were malignant and 8 (16%) were benign. Bile duct cancer (24 cases) was the most common. Nineteen postoperative complications developed in 13 patients, and 4 patients developed more than 2 complications. According to the Clavien–Dindo Classification, postoperative complications were grade I in 8 cases, grade II in 6, grade IIIA in 2, grade IIIB in 2, and grade V in 1. The morbidity rate was 38%. The median time to drain removal was 8 days, and the median length of postoperative hospital stay was 14 days. POPF occurred in 4 cases, resulting in a POPF rate of 8%. POPF-related mortality occurred in 1 case. Conclusion: Based on our 50-case experience, we believe that Peng's BPG is a good surgical option to minimize the occurrence of POPF but more investigations including comparative study with pancreaticojejunostomy are needed.

Caveolin-1-ROS feedforward in PSC induces stroma-tumor metabolic coupling in pancreatic cancer

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.

Perineural invasion and pancreatic cancer

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.

Clinical application of binding pancreaticogastrostomy anastomosis in medial pancreatectomy

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.

A multicentered randomized controlled trial comparing binding pancreaticojejunostomy to a novel binding pancreaticogastrostomy

A multicentered randomized controlled trial comparing binding pancreaticojejunostomy to a novel binding pancreaticogastrostomy

The initial report for the quality of life in patients who underwent binding pancreaticogastrostomy (BPG)

The initial report for the quality of life in patients who underwent binding pancreaticogastrostomy (BPG)

Clinical application of binding pancreaticogastrostomy in the central pancreatectomy

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

Binding pancreaticogastrostomy in laparoscopic central pancreatectomy: a novel technique in laparoscopic pancreatic surgery.

Even though more and more cases of laparoscopic central pancreatectomy (LCP) are reported (Machado et al. in Surg Laparosc Endosc Percutan Tech 23(6):486-490, 2013; Hong et al. in World J Surg Oncol 10:223, 2012; Gonzalez et al. in JOP 14(3):273-276, 2013, Zhang et al. in J Laparoendosc Adv Surg Tech A 23(11):912-918, 2013; Sucandy et al. in N Am J Med Sci 2(9):438-441, 2010; Sa Cunha et al. in Surgery 142(3):405-409, 2007), the management for pancreatic stumps remains the most technically challenging part which is the same as in pancreatoduodenectomy (PD), making it the bottleneck for laparoscopic pancreatic surgery. In open surgery, various pancreatic reconstruction techniques designed for either pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG) have been attempted to reduce the postoperative pancreatic fistula (POPF), including the binding anastomosis, invented by our team, i.e., binding PG (BPG) and binding PJ, which have been proved to be effective to reduce the POPF (Hong et al. 2012; Peng et al. in Ann Surg 245(5):692-698, 2007; Peng et al. in Updates Surg 63(2):69-74, 2011). However, despite of this, few reports are seen addressing such technique for laparoscopic surgery even though laparoscopic pancreatic surgery is more performed. After a previous successful laparoscopic BPG in a case of laparoscopic CP (LCP; Hong et al. 2012) and more than 50 cases of open PD and CP (Peng et al. 2011), we further performed laparoscopic BPG in 10 consecutive cases of LCP with satisfactory outcomes. To explore the feasibility and efficacy of LCP with BPG. Between October 2011 and July 2014, LCP with laparoscopic BPG was performed in ten consecutive patients with lesions of benign or low malignancy at the pancreatic neck. Operative and pathological data, complications, hospital stay and details on the surgical techniques were introduced. The operations were successfully performed in all the ten cases, with no conversions. The tumor size ranged from 2.0-3.0 to 2.5-3.0 cm, average (2.50 ± 0.35) to (2.66 ± 0.35) cm, and the diameter of pancreatic duct was (1.6-2.1) mm, average (1.71 ± 0.17) mm. Operation time was 170-250 (198.50 ± 25.82) min, and blood loss was 20-300 (125 ± 107.31) mL. Three cases had grade A pancreatic fistula (PF), and one case had delayed gastric emptying, which were all managed with conservative treatment. Upper GI bleeding occurred in one case which was cured with second operation, time for the recovery of bowl movement was 3-5 (4.2 ± 0.8) days, the time for semifluid dieting was 6-10 (8.2 ± 1.5) days, and the hospital stay was 8-20 (12.8 ± 4.63) days. The postoperative fast blood sugar was (6.3 ± 1.6) mmol/L with the normal diet, which was not significantly different from the preoperative data (5.3 ± 0.5) mmol/L (P > 0.05). The postoperative pathology was as follows: five cases of cystic serous adenoma, one case of intraductal papillary mucinous neoplasm, two cases of neuroendocrine tumor, and two cases of solid pseudopapillary tumor of pancreas. All the patients were followed up for 7-40 months, no recurrence happened, and no new incidence of diabetes or insufficiency of pancreatic exocrine function occurred. LCP with BPG is feasible and safe; the advantages lie in its minimal invasiveness, the efficacy for avoiding PF, and the preservation of the pancreatic endocrine and exocrine function insufficiency, making it an ideal procedure for the benign or low-malignant lesions at the pancreatic neck.

Reconstruction of pancreatic enteric anastomosis after pancreaticoduodenectomy

Pancreatic enteric anastomosis is an important step during pancreaticoduodenectomy. Based on the anastomosis site, pancreatic enteric anastomosis is classified as pancreaticojejunostomy anastomosis and pancreaticogastrostomy. Depending on the jejunum site, reconstruction can be perform as end-to-end or end-to-side anastomosis. Previous randomized clinical trials, showed no significant differences between pancreaticojejunostomy and pancreaticogastrostomy. Binding pancreaticojejunostomy and binding pancreaticogastrostomy are easy to perform. The rate of pancreatic leakage is related to the texture of the pancreas and the size of the pancreatic duct. It is helpful to reduce pancreatic leakage by placing a pancreatic duct stent. The simple and effective pancreatic enteric reconstruction is the future direction for minimizing leakage.

Experiences of binding pancreaticogastrostomy: a report of 36 cases

To summarize the experiences of binding pancreaticogastrostomy in pancreatoduodenectomy. Retrospective analysis was performed for the data of 36 patients undergoing pancreatoduodenectomy from January 2010 to January 2013. Binding pancreaticogastrostomy was used to reconstruct digestive tract. The postoperative complications were observed. And follow-ups were conducted on the patency of anastomotic stoma of pancreatogastrostomy and pancreatic duct. All operations were successful. There were simple pancreatic fistula (n = 7, 19.4%), upper gastrointestinal tract bleeding (n = 2, 5.6%), delayed gastric emptying (n = 1), intra-abdominal infection (n = 1) and infection of incision (n = 3). All were cured with conservative therapy. There was no instance of bile leakage, intra-abdominal bleeding, reoperation or in-hospital mortality. Binding pancreaticogastrostomy causes no serious pancreatic fistula and complications. And it is a safe and reliable reconstructive approach with manageable follow-ups.

Endoscopic treatment of upper gastrointestinal hemorrhage after binding pancreaticogastrostomy

Objective To study endoscopic treatment of upper gastrointestinal hemorrhage after binding pancreaticogastrostomy. Methods We colleted data of all patients who developed upper gastrointestinal bleeding after binding pancreaticogastrostomy from January 2009 to December 2011. We treated hemorrhage with different methods including thrombin spray, APC, tissue adhesive agents and evaluated the effect of different treatments. Results There were 5 patients with postoperative hemorrhage. One was cured by thrombin spray and APC. Four others received tissue adhesive injection. All patients were cured and no one received surgery. Conclusion The tissue adhesive injection is an effective method to treat the postoperative hemorrhage of Secondary surgerycan be avoided Key words: Hemorrhage; Binding pancreaticogastrostomy; Endoscopic treatment

Binding pancreaticoenteric anastomosis: from binding pancreaticojejunostomy to binding pancreaticogastrostomy

Potential mechanisms of occurrence of pancreatic leakage mainly include leakage from the needle hole and from the seam at the adjacent stitch, anastomotic blood supply, tension at the anastomosis, poor anastomotic healing, etc. Binding pancreaticojejunostomy (BPJ) is a safe and effective technique that avoids the primary complication of pancreatic anastomosis leakage. There are two problems with BPJ: a high discrepancy in the size of pancreas stump and the jejunal lumen; sutures on to the pancreas for fixation might cause exudation of pancreatic juice into the abdominal cavity. In order to avoid these two problems, binding pancreaticogastrostomy (BPG) is designed and successfully performed clinically with encouraging results. BPG is good for accommodating a large pancreas stump, and the binding technique is very helpful in minimizing the leak rate of pancreaticogastrostomy.