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Pancreatogastrostomy with an elastic purse-string suture around the gastric orifice after pancreatoduodenectomy

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Postoperative pancreatic fistula (POPF) is a potentially fatal complication of pancreatoduodenectomy (PD). Fixation of the remnant pancreas to the gastric wall is considered essential to prevent anastomotic leakage in patients undergoing pancreatogastrostomy (PG) after PD. PG was performed with invagination of the pancreatic stump. To limit the number of sutures in the pancreas parenchyma to three or four, we placed an elastic purse string suture around the orifice of the posterior gastric wall in an attempt to fix the gastric wall to the remnant pancreas. We performed PG using this technique in 30 patients. According to the international POPF criteria, POPF developed in three (10%) patients; as grade A in one, and grade B in two. These results demonstrate the potential advantage of performing PG after PD, by using this invaginated technique with an elastic suture.

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Nishizaki, T., Ijichi, H., Terashi, T. et al. Pancreatogastrostomy with an elastic purse-string suture around the gastric orifice after pancreatoduodenectomy. Surg Today 39, 548–551 (2009).

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