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01.12.2015 | Technical advance | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy—A novel pancreatic-gastric anastomosis technique -

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Masamichi Matsuda, Shusuke Haruta, Hisashi Shinohara, Kazunari Sasaki, Goro Watanabe
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12893-015-0061-x) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MM, SH, HS, and KS performed the surgical procedures. MM and KS collected the data, prepared the manuscript, and contributed to the analysis and interpretation of the results. GW contributed to the analysis and interpretation of the results. All authors read and approved the final manuscript.

Abstract

Background

Although many surgical procedures are now routinely performed laparoscopically, pure laparoscopic pancreaticoduodenectomy (LPD) is not commonly performed because of the technical difficulty of pancreatic resection and the associated reconstruction procedures. Several pancreatic-enteric anastomosis techniques for LPD have been reported, but most are adaptations of open procedures. To accomplish pure LPD, we consider it necessary to establish new pancreatic-enteric anastomosis techniques that are specifically developed for LPD and are safe and feasible to perform.

Results

One patient developed a postoperative pancreatic fistula (International Study Group of Pancreatic Fistula criteria, grade B) and subsequent postoperative delayed gastric emptying (International Study Group of Pancreatic Surgery criteria, grade C). No other major complications occurred. We developed a novel pancreatic-gastric anastomosis technique that enabled us to safely perform pure LPD. The main pancreatic duct was stented with a 4-Fr polyvinyl catheter during pancreatic resection. A small hole was created in the posterior wall of the stomach and was bluntly dilated. A 5-cm incision was made in the anterior stomach, and the pancreatic drainage tube was passed into the stomach through the hole in the posterior wall. The remnant pancreas was pulled into the stomach, and was easily positioned and secured in place with only four to six sutures between the pancreatic capsule and the gastric mucosa. We used this technique to perform pure LPD in five patients between December 2012 and July 2013.

Conclusions

Our new technique is technically easy and provides secure fixation between the gastric wall and the pancreas. This technique does not require main pancreatic duct dilatation, and the risk of intra-abdominal abscess formation due to postoperative pancreatic fistula may be minimized. Although this technique requires further investigation as it may increase the risk of delayed gastric emptying, it may be a useful method of performing pancreaticogastrostomy in pure LPD.

Trial registration

ISRCTN16761283. Registered 16 January 2015.
Literatur
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