Buttressed pancreaticogastrostomy for a soft pancreas and/or small pancreatic duct in pancreaticoduodenectomy: A retrospective cohort study

Abstract

Objective

Post-operative pancreatic fistula (POPF) has a major impact on the post-operative outcomes after pancreaticoduodenectomy (PD). Soft pancreas and small pancreatic duct diameter are major risk factors for POPF. In this study, we aimed to evaluate the short-term outcomes of our technique of buttressed pancreaticogastrostomy (PG) as a method of pancreatic anastomosis.

Patients and Methods

A retrospective cohort study was conducted on patients who underwent PD with a soft pancreas and/or small pancreatic duct diameter ≤5 mm. The study period spanned from January 2018 to December 2022.

Results

A total of 69 patients were included in the study, comprising 30 females and 39 males. The mean age of the patients was 57 ± 14.3 years. The mean operative time of the whole procedure was 335 ± 43.7 min and that of buttressed PG was 22 ± 4.6 min. Two patients had early post-operative bleeding. Only 5 (7.24%) patients developed a grade A POPF. Eight (11.8%) patients had delayed gastric emptying.

Conclusion

Buttressing PG represents a simple and safe reconstruction technique following PD, particularly for patients with a soft pancreas and/or small pancreatic duct. This approach is associated with a low incidence of POPF. However, prospective randomised trials with large sample sizes are required to confirm these results.