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Trans-gastric pancreaticogastrostomy reconstruction after pylorus-preserving robotic Whipple: a proposal for a standardized technique

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Abstract

Background

A number of technical improvements regarding the pancreatic anastomosis have decreased the morbidity and mortality after pancreaticoduodenectomy. However, postoperative pancreatic fistula (POPF) remains is the most feared complication, and the ideal technique for pancreatic reconstruction is undetermined.

Materials and methods

This study is a retrospective review of a prospectively maintained database. Data were collected from all consecutive robot-assisted pancreaticoduodenectomies (RAPD), performed by a single surgeon, at the University of Illinois Hospital & Health Sciences System, between September 2007 and January 2016.

Results

A total of 28 consecutive patients (16 male and 12 female) who underwent a RAPD were included in this study. Patients had a mean age and mean BMI of 61.5 years (SD = 12.3) and 27 kg/m2 (SD = 4.9), respectively. The mean operative time was 468.2 min (SD = 73.7) and the average estimated blood loss was 216.1 ml (SD = 113.1). The mean length of hospitalization was 13.1 days (SD = 5.4). There was no clinically significant POPF registered.

Conclusion

Trans-gastric pancreaticogastrostomy (TPG) represents a valid and feasible option as a pancreatic digestive reconstruction during RAPD. Initial results showed decreased incidence of POPF with an increased risk of postoperative bleeding. Our experience suggests that TPG might be safer than pancreaticojejunostomy (PJ); further studies are needed in order to confirm.

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Acknowledgements

We would like to thank and acknowledge Zaid Zayyad for his contribution with designing the drawings in the paper.

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Authors and Affiliations

  1. Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 435E, mail code 958, Chicago, IL, 60612, USA

    Pier C. Giulianotti, Raquel Gonzalez-Heredia, Sofia Esposito, Mario Masrur, Antonio Gangemi & Francesco M. Bianco

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  1. Pier C. Giulianotti
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  2. Raquel Gonzalez-Heredia
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  3. Sofia Esposito
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  4. Mario Masrur
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  5. Antonio Gangemi
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  6. Francesco M. Bianco
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Corresponding author

Correspondence to Raquel Gonzalez-Heredia.

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Disclosures

Raquel Gonzalez-Heredia, Sofia Esposito, Mario Masrur, Antonio Gangemi, and Francesco M. Bianco have no conflicts of interest or financial ties to disclose. Dr. Giulianotti is a consultant for Covidien LP. and Ethicon, Inc.; he has a proctoring agreement and Grant support as Chief of the Division.

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Giulianotti, P.C., Gonzalez-Heredia, R., Esposito, S. et al. Trans-gastric pancreaticogastrostomy reconstruction after pylorus-preserving robotic Whipple: a proposal for a standardized technique. Surg Endosc 32, 2169–2174 (2018). https://doi.org/10.1007/s00464-017-5916-z

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  • DOI: https://doi.org/10.1007/s00464-017-5916-z

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