Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

Introduction. Although in recent years there have been various versions of pancreatic – digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.
Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.
Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico – digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ducto-mucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).
Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.
Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.