Ann Surg Treat Res.  2022 Oct;103(4):217-226. 10.4174/astr.2022.103.4.217.

Conversion to pancreaticogastrostomy for salvage of disrupted pancreaticojejunostomy following pancreaticoduodenectomy

Affiliations
  • 1Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea

Abstract

Purpose
This study aimed to report on a pancreas-preserving strategy consisting of the conversion to pancreaticogastrostomy (PG) for the salvage of disrupted pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD).
Methods
This single-center retrospective study included 188 patients who underwent PD between March 2000 and June 2021. Conversion to PG was performed by placing the pancreatic stump with an internal stent in the stomach through the posterior gastrostomy and suturing the wound in 2 layers through the anterior gastrostomy.
Results
A total of 181 patients underwent PJ, while 7 underwent PG. Of all patients, 6 had International Study Group on Pancreatic Fistula grade C postoperative pancreatic fistulae (POPF; 3.3%) and 23 had grade B POPF (12.7%). Two of the 6 grade C patients underwent completion pancreatectomy and died of liver failure after common hepatic artery embolization due to pseudoaneurysm. Conversion to PG was performed in 4, all of whom survived and experienced no long-term pancreatic fistulae, remnant pancreatic atrophy, or newly developed diabetes after a median follow-up period of 11.5 months.
Conclusion
Conversion to PG for the salvage of disrupted PJ following PD is safe and effective in selected patients that can lower mortality rates while maintaining pancreatic function.

Keyword

Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticogastrostomy; Pancreaticojejunostomy

Figure

  • Fig. 1 Axial computed tomography image taken after the index operation. Disrupted pancreaticojejunostomy with peripancreatic fluid collection and an associated “gap” (arrows) between the jejunum and the remnant pancreas margin is visible.

  • Fig. 2 Schematic drawing of the pancreaticogastrostomy technique. (A) The pancreatic stump with an internal stent was placed in the stomach through the posterior gastrostomy. (B) A continuous suture was placed between the remnant pancreas and the posterior wall of the stomach in 2 layers through the anterior gastrostomy.

  • Fig. 3 Axial computed tomography image taken after the pancreaticogastrostomy. The pancreatic stump with internal stent (arrow) is visibly protruding into the stomach lumen after conversion to pancreaticogastrostomy.

  • Fig. 4 Incidence and management of postoperative pancreatic fistulae (POPF) in the study population according to International Study Group on Pancreatic Fistula grade. BL, biochemical leak.


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