GK News 2 - шаблон joomla Видео


Log in
Powered by Spearhead Software Labs Joomla Facebook Like Button


Daniel Vasilev Kostov1, Georgi Kobakov2, Daniel Yankov1

1) Department of Surgery, Naval Hospital of Varna, Bulgaria.

2) Division of Surgery, Specialized Hospital of Oncological Diseases of Varna, Varna, Bulgaria.

Disclosure: The author has declared no conflicts of interest.

Received: 30.03.15 Accepted: 20.04.15

1486385429 Quote  doi: 10.5455/ijsm.20150411090731

pdf icon  Fulltext PDF Download

export icona  EndNote/RefWorks

statistics market icon32  Article Statistics


One of the most feared complications after pancreaticoduodenectomy (PD) remains postoperative pancreatic fistula (POPF). In the current study, we demonstrate a new technique for pancreaticogastrostomy (PG), using one continuous seromuscular circular suture without trans pancreas sutures for PG.

Material and Methods
During the period December 2012 to December 2014, 32 consecutive patients underwent PD (either pylorus-preserving or classical Whipple’s) carried out using the above suture-less PG. Indication for PD was pancreatic duct carcinoma. Procedures were carried out by the same surgeon, same approach and anastomotic method in order to avoid technical changes.

Postoperative mortality was zero and morbidity was 21.8% (n=7). Pancreatic leakage (Grade A/B) occurred in 2 (6.2%) patients. These pancreatic leaks were managed nonoperative by maintaining the closed drains. The most common postoperative complication delayed gastric emptying (Grade B/C) in 3 (9.3%) patients.

We conclude that the suture-less PG possesses several advantages over conventional PG and pancreaticojejunostomy (PJ). This technic seems to lessen the risk of a pancreatic leak, probably by diminishing the possibility of suture damage to the pancreas and by embedding the transected stump into the posterior gastric wall. This novel PG is a valid and valuable procedure, especially for soft, nonfibrotic pancreas.

Keywords: Pancreaticoduodenectomy; Pancreaticogastrostomy; Suture-less pancreaticogastrostomy; Postoperative pancreatic fistula


1. Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10-15. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]
2. Balcom IVJH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients and decreasing length of hospitalization. Arch Surg 2001;136:391-398. [DOI via Crossref]
3. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg 2007;11:1451-1458. [DOI via Crossref] [Pubmed]
4. Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248-257; discussion 257-260.
5. Veillette G, Dominguez I, Ferrone C, Thayer SP, McGrath D, Warshaw AL et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg 2008;143:476-481. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]
6. Lermite E, Pessaux P, Brehant O, Teyssedou C, Pelletier I, Etienne S, Arnaud JP: Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J AmColl Surg 2007; 204:588-596.
7. Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg 2009;208:738-747 [DOI via Crossref] [Pubmed]
8. Yang SH, Dou KF, Sharma N, Song WJ. The methods of reconstruction of pancreatic digestive continuity after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. World J Surg 2011;35:2290-2297. [DOI via Crossref] [Pubmed]
9. Lai EC, Lau SH, Lau WY. Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review. Arch Surg 2009;144:1074-1080. [DOI via Crossref] [Pubmed]
10.Whipple AO. The rationale of radical surgery for cancer of the pancreas and ampullary region. Cancer Pancreas Ampulla 1941;114:1-4. [DOI via Crossref]
11.Duffas JP, Suc B, Msika S, Fourtanier G, Muscari F, Hay JM et al. A controlled randomized multicentre trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy. Am J Surg 2005;189:720-729. [DOI via Crossref] [Pubmed]
12.McKay A, Mackenzie S, Sutherland FR, Bathe OF, Doig C, Dort J et al. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy. Br J Surg 2006;93:929-936. [DOI via Crossref] [Pubmed]
13.Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak MS, Talamini MD et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580-592. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]
14.Figueras J, Sabater L, Planellas P, Mu-oz-Foner E, Lopez-Ben S, Falgueras L et al. Randomized clinical trial of pancreatico pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br J Surg 2013;100:1597-1605. [DOI via Crossref] [Pubmed]
15.Topal B, Fieuws S, Aerts R, Weerts J, Feryn T, Roeyen G et al. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomized trial. Lancet Oncol 2013;14:655-662. [DOI via Crossref]
16.Wellner HF, Sick O, Olschewski M, Adam U, Hopt UT, Keck T. Randomized controlled single-centre trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J Gastrointest Surg 2012;16:1686-1695. [DOI via Crossref] [Pubmed]
17.Peng SY, Hong DF, Liu YB, Li JT, Tao F, Tan ZJ. A pancreas suture-less type II binding pancreaticogastrostomy. Zhonghua Wai Ke Za Zhi 2009;47:1764-1766.
18.Peng SY, Liu YB, Hong DF, Li JT, Tao F, Tan ZJ. Peng’s pancreaticogastrostomy—comparative study on types I and II procedures (with types III and IV appended). J Surg Concepts Pract 2009;14:5.
19.Zhu F, Wang M, Wang X, Tian R, Shi Ch, Xu M et al. Modified technique of pancreaticogastrostomy for soft pancreas with two continuous hemstitch sutures: a single-center prospective study. J Gastrointest Surg 2013;17:1306-1311. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]
20.Fernández-Cruz L, Cosa R, Blanco L, López-Boado, Miguel Angel MA, Astudillo E. Pancreatogastrostomy with gastric partition after pylorus-preserving pancreatoduodenectomy versus conventional pancreatojejunostomy: aprospective randomized study. Ann of Surg. 2008;248(6):930-938. [DOI via Crossref] [Pubmed]
21.Payne RF, Pain JA. Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy. Br J Surg. 2006;93(1):73-7. [DOI via Crossref] [Pubmed]
22.Winter JM, Cameron JL, Campbell KA, Chang DC, Riall TS, Schulick RD et al. (2006) Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 2006;10:1280-1290. [DOI via Crossref] [Pubmed]
23.Lowy AM, Lee JE, Pisters PW, Davidson BS, Fenoglio CJ, Stanford P et al. Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Ann Surg 1997;226:632-641. [DOI via Crossref] [Pubmed] [PMC Free Fulltext]
24.Lillemoe KD, Cameron JL, Kim MP, Campbell KA, Sauter PK, Coleman JA et al. Does fibrin glue sealant decrease the rate of pancreatic fistula after pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 2004;8:766-772. [DOI via Crossref] [Pubmed]
25.Wente MN, Shrikhande SV, Müller MW, Diener MK, Seiler CM, Friess H et al. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 2007;193:171-183. [DOI via Crossref] [Pubmed]
26.Hallet J, Zih F, Deobald R, Scheer A, Law C, Coburn N, Karanicolas P. The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta-analysis of randomized controlled trials. HPB 2015;17:113-122.
27.Liu FB, Chen JM, Geng W, Xie SX, Zhao YJ, Yu LQ et al. Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of seven randomized controlled trials. HPB 2015;17:123-130.
28.Arnaud JP, Tuech JJ, Cervi C, Bergamaschi R. Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg 1999; 165:357-362. [DOI via Crossref] [Pubmed]
29.Takano S, Ito Y, Watanabe Y, Yokoyama T, Kubota N, Iwai S. Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 2000;87:423-427. [DOI via Crossref] [Pubmed]
30.Oussoultzoglou E, Bachellier P, Bigourdan J-M, Weber J-C, Nakano H, Jaeck D. Pancreaticogastrostomy decreased relaparotomy caused by pancreatic fistula after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg 2004;139:327-335. [DOI via Crossref] [Pubmed]
31.Miyagawa S, Makuuchi M, Lygidakis NJ, Noguchi T, Nishimaki K, Hashikura Y et al. A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy-pancreaticojejunostomy vs. pancreaticogastrostomy. Hepatogastroenterology 1992; 39:381-384.
32.Bartsch DK, Langer P, Kanngiesser V, Fendrich V, Dietzel K: A simple and safe anastomosis for pancreatogastrostomy using one binding purse-string and two transfixing mattress sutures. Int J Surg Oncol, 2012:718637

How to Cite this Article


Kostov, D., Kobakov, G. and Yankov, D. (2015) ‘PANCREATOGASTROSTOMY WITH ONE CONTINUOUS SEROMUSCULAR CIRCULAR SUTURE’, International Journal of Surgery and Medicine, 1(1), pp. 2–6. doi: 10.5455/ijsm.20150411090731.

Citations, Quotes & Annotations

Kostov, D., Kobakov, G. and Yankov, D. (2015) ‘PANCREATOGASTROSTOMY WITH ONE CONTINUOUS SEROMUSCULAR CIRCULAR SUTURE’, International Journal of Surgery and Medicine, 1(1), pp. 2–6. doi: 10.5455/ijsm.20150411090731.
(Kostov, Kobakov, and Yankov, 2015)

Cited by:

1. Kostov D, Kobakov G. Is Sutureless Pancreaticogastrostomy More Effective than Single-Layer Duct-to-Mucosa Pancreaticojejunostomy in Pancreaticoduodenectomy? The Eurasian Journal of Medicine. 2017;49(2):79-86. doi:10.5152/eurasianjmed.2017.17002.

2. Godara R, Tamaknand V, Verma S. A novel pancreatogastrostomy method using only one purse string suture and four corner mucosal sutures: early post operative surgical results. Int J Surg Med. 2018; 4(1): 28-32. doi:10.5455/ijsm.pancreatogastrostomy-using-only-one-purse-string-suture-four-corner-mucosal-sutures

3. Kostov, Daniel Vasilev. “Lymphadenectomy in Pancreatic Cancer Surgery.” (2016).

4. Kostov, Daniel, Georgi Kobakov, and Daniel Yankov. "Mesopancreas excision for pancreatic head adenocarcinoma". Surg Chron 2016; 21(3): 117-121


Last modified onSaturday, 18 August 2018 09:25