A novel pancreaticogastrostomy technique of PG after PD: transpancreatic suture with a However a simply biochemical pancreatic fistula, which buttress method through an anterior gastrotomy, and this was classified into grade A, was not defined as a pancreatic can provide an easy, secure pancreatoenteric anastomosis. fistula in this report. Delayed gastric emptying was de- We also discuss this procedure’s effectiveness for reducing fined as being present when postoperative nasogastric the incidence of postoperative complications. METHODS Patients and methods suction was required for more than 10 days combined with a failure to progress with oral feeding. Surgical techniques After resection of the pancreatic head and duodenum with or without preservation of the pylorus, the pancreatic The study was approved by Institutional Review Board stump is freed from retroperitoneal attachments for about of the Ethical Committee of hospital. This novel PG has 4 cm. The duct of Wirsung is identified and incannulated been used in 21 consecutive patients by two surgeons at two institutions between May 2010 and January 2011. The data was prospectively collected and then retrospectively reviewed. Reviewed data included patient demographics (age, sex, and diagnosis), type of operation (standard PD or PPPD), a texture of pancreas, operating time, blood loss, postoperative hospitalization, operative mortality, and complications. We defined a pancreatic fistula as a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity, according to the International Study Group on Pancreatic Fistula (ISGPF) recommendations. Fig. 2. A longitudinal gastrotomy in the anterior gastric wall just above the presumed site of the pancreaticogastrostomy in the posterior gastric wall is performed with an ultrasound scissors (Harmonic Scalpel UltraCision, Ethicon Endo-Surgery Inc., Cincinnati, Ohio, USA). Fig. 1. Two stay sutures on both ends of the pancreatic stump. After resection of the pancreatic head and duodenum, the pancreatic stump is freed about 4 cm from all retroperitoneal attachments. The duct of Wirsung is incannulated with a short stent tube and 2 stay sutures on both ends of the pancreatic stump are applied for traction. thesurgery.or.kr Fig. 3. A transverse gastrotomy was made on the serosal surface of the posterior gastric wall with electrocautery in accordance with the 3/4 diameter of the pancreatic stump. 333