A study on outcome of binding pancreaticogastrostomy following pancreaticoduodenectomy: A prospective observational study

Abstract

This novel method of binding PG is simple, secure, and reproducible. It possesses several advantages over the conventional PG: it is very easy to perform, it is less traumatic to the pancreatic stump, can be performed in all types of pancreatic stump irrespective of the texture and diameter of the pancreatic duct without any statistically significant adverse outcomes.

Binding pancreaticogastrostomy after pancreaticoduodenectomy and central pancreatectomy

“…Although the technique appears simple and excellent results were reported in several series with similar technique, 8–13 the author identified several drawbacks in the early experience that led to major complications. Similar to the earlier series of non‐binding type of pancreaticogastrostomy, gastrointestinal bleeding remains a problem 14–16 .…”

“…Causes include incomplete sealing of the pancreas stump by the gastric wall, pancreas necrosis by excessive tightening of the purse string, pancreas fracture due to inappropriate position of posterior gastrotomy (Figure 1), cutting into the pancreas by the purse string suture and slipping of the pancreas back into the peritoneal cavity due to insecure anchoring. To ensure anchorage of the pancreas stump, complete circumferential and full thickness suturing of the stomach wall to the pancreas, rather than suturing to gastric mucosa only as advocated by some authors 8,9 is perhaps the most secure way. To avoid cutting into the pancreas by the purse string suture, the outer purse string suture is preferably placed about 1.5 cm from the edge of the posterior gastrotomy and the gastrotomy is inverted by the inner purse string pulling into the stomach, so that on tightening of the outer purse string, there is a layer of gastric wall around the pancreas serving as a cushion (Figure 2).…”

“…[14][15][16] Bleeding may occur from the pancreatic stump inside the stomach by acid erosion. In the case of binding pancreaticogas- wall to the pancreas, rather than suturing to gastric mucosa only as advocated by some authors 8,9 is perhaps the most secure way. To avoid cutting into the pancreas by the purse string suture, the outer purse string suture is preferably placed about 1.5 cm from the edge of the posterior gastrotomy and the gastrotomy is inverted by the inner purse string pulling into the stomach, so that on tightening of the outer purse string, there is a layer of gastric wall around the pancreas serving as a cushion (Figure 2).…”