J Korean Surg Soc 2011;81:332-338 http://dx.doi.org/10.4174/jkss.2011.81.5.332 ORIGINAL ARTICLE JKSS Journal of the Korean Surgical Society pISSN 2233-7903ㆍeISSN 2093-0488 An easy and secure pancreaticogastrostomy after pancreaticoduodenectomy: transpancreatic suture with a buttress method through an anterior gastrotomy Tae Ho Hong, Young Chul Youn1, Young Kyoung You, Dong Goo Kim Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Seoul, 1Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Incheon, Korea Purpose: The aim of this report was to describe a new reconstructive technique of pancreaticogastrostomy and to also discuss this procedure’s effectiveness for reducing the incidence of postoperative complications. Methods: We retrospectively ana- lyzed early surgical outcomes in 21 consecutive patients who underwent this novel pancreaticogastrostomy after pancreaticoduodenectomy. Pancreaticogastrostomy was completed with 2 transpancreatic sutures with buttresses on both the upper and lower edges of the implanted pancreas through the retracted anterior gastrotomy. Results: Operative mortality was zero and morbidity was 23.8%. A significant pancreatic fistula occurred in 1 patient (4.7%; grade B). Conclusion: This technique is very easy to perform, less traumatic to the pancreatic stump, can be performed through a mini-laparotomy due to good vision and straight sutures, and it is secure owing to anchoring of the invaginated pancreatic stump to the stomach’s posterior wall with buttresses. The results of this pilot study indicate that the technique may provide a favorable outcome and could be an alternative method of pancreatoenteric anastomosis. However, to determine its superiority over the conven- tional procedures, this operative technique should be evaluated more comprehensively in a larger series. Key Words: Pancreatic fistula, Pancreatoenteric anastomosis, Anterior gastrotomy INTRODUCTION Pancreaticogastrostomy (PG) has recently been reap- praised as a more secure procedure over pancreatico- Pancreatic anastomotic failure is the most important de- jejunostomy (PJ) and many reports support the lower rates terminant for morbidity and mortality following pan- of pancreatic anastomotic failure with PG than with PJ creatoduodenectomy (PD). Many reconstruction techni- [13-16]. Several different methods of anastomosing the ques have been extensively studied in the last two decades pancreas to the stomach have also been introduced with in an attempt to reduce the incidence of pancreatic fistula greatly improved results [5,12,15,17,18]. [1-12]. In the present report, we describe our reconstructive Received May 30, 2011, Revised July 4, 2011, Accepted July 28, 2011 Correspondence to: Young Kyoung You Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea School of Medicine, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: ＋82-2-2258-6102, Fax: ＋82-2-595-2992, E-mail: yky602@catholic.ac.kr cc Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2011, the Korean Surgical Society