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      • Single Purse-String Duct to Mucosa Pancreaticogastrostomy: A New Technique after Pancreaticoduodenectomy

        ( Xu’ An Wang ),( Ping Wang ),( Yingbin Liu ),( Shuyou Peng ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

        Aims: We developed a new technique termed the single purse-string duct to mucosa Pancreaticogastrostomy, which reduced the risk of pancreatic stump bleeding caused by gastric acid corrosion and decreased the pancreatic fistula rate than Pancreaticojejunostomy. Methods: Data were collected prospectively on 75 consecutive patients (43 men and 32 women; mean age 65.3 years who underwent pancreaticoduodenectomy using the single-string duct to mucosa Pancreaticogastrostomy. The technique was performed by the same surgeon and the key point is that pancreatic stump was placed between gastric mucosa and seromuscular layer.Pancreatic stump was covered with gastric mucosa and transfixed with it beside the pancreatic duct which was inserted with a silicone tube into the stomach lumen. finally, the gastric seromuscular layer was tied with the pancreas by a purse-string suture. Results: Mean time for PG anastomosis was 19 minutes (range 17 to 32 minutes), and mean blood loss was 380 mL (range 210 to 800 mL). There was no perioperative death. Over- all morbidity rate was 34.7% (26 of 75).Two patients had PF (overall rate was 2.7%) ,No one demonstrated a grade B or C postoperative PF.Postoperative abdominal hemorrhage developed in 2 patients (2.7%), no pancreatic stump bleeding occurs. Conclusions: These results suggest that our technique is effective. In addition to lower complication rates, this technique is easy to perform and mean time of the anastomosis was 19 minutes. This kind anastomosis is a reliable, safe, and easy to perform method. From our experiences, it appears to reduce the risk for pancreatic fistula and intragastric bleeding.

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