Open pancreaticogastrostomy after pancreaticoduodenectomy: a pilot study.
Management of the pancreatic stump following pancreaticoduodenectomy (PD) has always been a main source of concern among pancreatic surgeons. The present pilot study describes the reconstructive technique of anterior transgastric pancreaticogastrostomy (PG) after pylorus-preserving PD. Outcome in 50 patients with "soft" residual parenchyma treated with this technique is also reported. The average duration of the intervention was 351 minutes (range, 240-360); only two patients needed intraoperative transfusion with 2 units of blood. The postoperative period involved complications in 15 cases (30%). In particular, four patients developed pancreatic fistulas (8%), which were grade C in three cases (6%) and grade B in one patient (2%). Two patients (4%) presented with enteric fistula from erosion from a drain. Two patients experienced perianastomotic fluid collections associated with delayed gastric emptying (4%) and a clinically silent 5-cm abdominal collection was observed in an additional case. Bleeding of a gastric ulcer was treated in one case and four patients developed bronchopneumonia. None of the complications required a second surgical intervention and there were no deaths. One patient with a symptomatic fluid collection was treated by ultrasound-guided cutaneous drainage. The mean hospitalization time was 11.1 days (range, 8-25 days). The results obtained in this pilot study appear encouraging and merit further analysis in a randomized comparative trial.
Bassi
Claudio
C
Surgical and Gastroenterological Department, Hospital, University of Verona, Verona, Italy. claudio.bassi@univr.it
Butturini
Giovanni
G
Salvia
Roberto
R
Crippa
Stefano
S
Falconi
Massimo
M
Pederzoli
Paolo
P
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010865:Pilot Projects; D019651:Plastic Surgery Procedures / Q000379:methods*