Transgastric pancreaticogastric anastomosis: an alternative operative approach for middle pancreatectomy.

Abstract

OBJECTIVE:

To determine short-term outcomes following middle pancreatectomy with transgastric pancreaticogastric anastomosis.

DESIGN, SETTING, AND PATIENTS:

A retrospective analysis of 23 patients who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis at the Massachusetts General Hospital, Boston, from June 22, 2005, through April 29, 2009.

MAIN OUTCOME MEASURES:

Indications for procedure, operative time, length of stay, morbidity, mortality, and need for readmission, antibiotics, reoperation, additional procedures, or transfusion.

RESULTS:

The mean age of 15 women and 8 men who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis was 55.0 years. The median follow-up time was 12.9 months. The most commonly resected tumors were intraductal papillary mucinous neoplasms (n = 9), serous cystadenomas (n = 5), and neuroendocrine tumors (n = 4). The mean (SD) operative time was 191 (39) minutes. No patients required intraoperative transfusion. The median hospital stay was 5 days. The most common complications were pancreatic fistula (n = 6), intra-abdominal abscess (n = 4), and superficial skin infection (n = 4). Three patients had splenic artery pseudoaneurysms. Seven patients required readmission; 2 required reoperation. No patients developed postoperative new or worsening endocrine or exocrine insufficiency. There were no deaths.

CONCLUSIONS:

Middle pancreatectomy with transgastric pancreaticogastric anastomosis offers a safe alternative to the traditional Roux-en-Y pancreaticojejunostomy and may be technically simpler.

• Authors: Jennifer LaFemina, Parsia A Vagefi, Andrew L Warshaw, Carlos Fernández-del Castillo
• Journal: Archives of surgery (Chicago, Ill. : 1960) (Arch Surg) Vol. 145 Issue 5 Pg. 476-81 (May 2010) ISSN: 1538-3644 [Electronic] United States
• PMID: 20479347 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anastomosis, Surgical
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Pancreas (surgery)
• Pancreatectomy (adverse effects, methods)
• Pancreatic Fistula (epidemiology, pathology, prevention & control)
• Pancreatic Neoplasms (mortality, pathology, surgery)
• Retrospective Studies
• Stomach (surgery)
• Suture Techniques
• Treatment Outcome
• Young Adult