A novel pancreatogastrostomy method using only one purse string suture and four corner mucosal sutures: early post operative surgical results

Objective: Pancreatic fistula remains the single most important cause of morbidity following Pacreaticoduodenectomy (PD) and perhaps contributes most to increased mortality. Pancreaticogastrostomy (PG) has been used by many surgeons in recent years because of its theoretical advantages over Pancreaticojejunostomy (PJ). In this study, we analyzed outcome of modified binding PG technique following PD. Methods and Material: 20 consecutive patients were studied from April 2013 to March 2015 all of whom underwent binding PG after PD, where a single purse string suture was taken on the posterior wall of stomach with additional 4 mucosal corner sutures thereby creating a Pancreatico-gastric anastomosis. Results: We prospectively analyzed patient characteristics, perioperative outcomes and surgical results. In this study average age was 50.9 years with body mass index 21.5 ± 2.6 kg/m2 . All patients underwent classical PD and mean operative time was 377.5 ± 44.14 minutes.The mean operative time taken to complete pancreatogastrostomy after complete mobilization of pancreatic stump was 9.2 minutes(range 7-11minutes). Mean hospital stay was 16.55 ± 3.83 days (range, 8 to 21 days). Postoperative mortality was 5% (n=1) due to pneumonitis. Only two patients developed Grade A pancreatic fistula, which were managed conservatively. One patient had postoperative hemorrhage and four patients developed delayed gastric emptying (DGE). Conclusion: Results of our study are very promising, proving that modified binding PG is a simple, fast and safe reconstruction procedure after PD. However to determine its superiority over conventional PG, this procedure needs to be more comprehensively evaluated in larger group of patients.