title: A modified technique of pancreaticogastrostomy with short internal stent: A single surgeon's experience.
abstract: OBJECTIVE
  Postoperative pancreatic fistula (POPF) remains an important cause of morbidity and mortality after pancreaticoduodenectomy. Pancreaticogastrostomy (PG) as a reconstruction method after pancreaticoduodenectomy is a safe and optional surgical technique in decreasing the risk of POPF. In this study, a retrospective analysis was carried out to evaluate a new modification of PG technique that uses a two-layer anastomoses with an internal stent.
  
  
  METHODS
  Forty-seven patients underwent this newly modified PG technique between February 2012 and August 2016. Demographics, histopathological findings, type of surgery performed, perioperative parameters, postoperative length of stay, postoperative complications and interventional procedures, follow-up, and mortality data were collected and analyzed. Clavien-Dindo classification was used to grade the complications' severity.
  
  
  RESULTS
  Postoperative mortality was 4.25%, unrelated to POPF, and postoperative morbidity was 44.68%. Thirteen patients had severe (>Grade IIIa) complications, according to Clavien-Dindo classification. As classified in accordance to the International Study Group of Pancreatic Fistula, 24 (51.06%) patients developed Grade A POPF, and no occurrence of Grade B/C POPF was noted. All patients recovered uneventfully with successful treatment interventions.
  
  
  CONCLUSIONS
  The reported PG anastomotic technique is a safe and dependable reconstruction procedure with acceptable morbidity and mortality.
authors.affiliation: Department of Biological Sciences, Faculty of Science and Technology, Sunway University, Bandar Sunway, Selangor, Malaysia.
authors.forename: Pei Yi
authors.initials: PY
authors.lastname: Yap
authors.affiliation: Sunway Institute for Healthcare Development, Sunway University, Bandar Sunway, Selangor, Malaysia.
authors.forename: Jung Shan
authors.initials: JS
authors.lastname: Hwang
authors.affiliation: Sunway Institute for Healthcare Development, Sunway University, Bandar Sunway, Selangor, Malaysia; Department of Surgery, Sunway Medical Centre, Selangor, Malaysia. Electronic address: bongjj@gmail.com.
authors.forename: Jan Jin
authors.initials: JJ
authors.lastname: Bong
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015607:Stents; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome
keywords: pancreaticoduodenectomy; pancreaticogastrostomy; postoperative pancreatic fistula