title: Transgastric pancreaticogastric anastomosis: an alternative operative approach for middle pancreatectomy.
abstract: OBJECTIVE
  To determine short-term outcomes following middle pancreatectomy with transgastric pancreaticogastric anastomosis.
  
  
  METHODS
  A retrospective analysis of 23 patients who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis at the Massachusetts General Hospital, Boston, from June 22, 2005, through April 29, 2009.
  
  
  METHODS
  Indications for procedure, operative time, length of stay, morbidity, mortality, and need for readmission, antibiotics, reoperation, additional procedures, or transfusion.
  
  
  RESULTS
  The mean age of 15 women and 8 men who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis was 55.0 years. The median follow-up time was 12.9 months. The most commonly resected tumors were intraductal papillary mucinous neoplasms (n = 9), serous cystadenomas (n = 5), and neuroendocrine tumors (n = 4). The mean (SD) operative time was 191 (39) minutes. No patients required intraoperative transfusion. The median hospital stay was 5 days. The most common complications were pancreatic fistula (n = 6), intra-abdominal abscess (n = 4), and superficial skin infection (n = 4). Three patients had splenic artery pseudoaneurysms. Seven patients required readmission; 2 required reoperation. No patients developed postoperative new or worsening endocrine or exocrine insufficiency. There were no deaths.
  
  
  CONCLUSIONS
  Middle pancreatectomy with transgastric pancreaticogastric anastomosis offers a safe alternative to the traditional Roux-en-Y pancreaticojejunostomy and may be technically simpler.
authors.affiliation: Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: LaFemina
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-del Castillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult