title: A novel technique of inserting pancreaticogastrostomy with duct-to-mucosa anastomosis can potentially reduce postoperative pancreatic fistula.
abstract: We describe our novel technique of inserting pancreaticogastrostomy (IPG) after pancreaticoduodenectomy. In our technique, the seromuscular and mucosal layers of the posterior gastric wall are separated to create a mucosal pouch. A duct-to-mucosa anastomosis is performed through a small incision in the mucosal layer. An inner suture at the seromuscular-mucosal margin incorporating the pancreatic parenchyma and an outer suture on the exterior margin of the seromuscular layer to wrap the pouch around the pancreas are placed to complete the IPG.
  
  
  
  We examined the clinicopathological features and outcomes of 259 patients who underwent pancreaticoduodenectomy between January 2010 and April 2014.
  
  
  
  One hundred forty-three (55.2%) patients underwent IPG, while 116 (44.8%) had conventional pancreaticojejunostomy. Most preoperative and intraoperative parameters were comparable. Overall morbidity in the IPG group was 28.7%. The rate of grade A postoperative pancreatic fistula (POPF) was 7.0%, and the rates of grade B and C POPF were 0.7% and 0.0%, respectively. The corresponding rates of grade A, B, and C fistulae were 5.2%, 8.6%, and 5.2%, respectively.
  
  
  
  In selected patients, our novel technique can be performed safely and may reduce the rates of POPF.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Lihuili Eastern Hospital, Medical Center of Ningbo and Ningbo University, Ningbo, China. Electronic address: lucaide@nbu.edu.cn.
authors.forename: Cai-de
authors.initials: CD
authors.lastname: Lu
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Lihuili Eastern Hospital, Medical Center of Ningbo and Ningbo University, Ningbo, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Lihuili Eastern Hospital, Medical Center of Ningbo and Ningbo University, Ningbo, China.
authors.forename: Yong-Fei
authors.initials: YF
authors.lastname: Hua
authors.affiliation: Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ammar Asrar
authors.initials: AA
authors.lastname: Javed
authors.affiliation: Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jin
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Lihuili Eastern Hospital, Medical Center of Ningbo and Ningbo University, Ningbo, China.
authors.forename: Sheng-Dong
authors.initials: SD
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Lihuili Eastern Hospital, Medical Center of Ningbo and Ningbo University, Ningbo, China.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Yu
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Lihuili Eastern Hospital, Medical Center of Ningbo and Ningbo University, Ningbo, China.
authors.forename: Chang-Jiang
authors.initials: CJ
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Inserting pancreaticogastrostomy; Pancreaticoduodenectomy; Pancreaticogastrostomy; Postoperative pancreatic fistula