A simplified stent-bridging pancreaticogastrostomy during pancreaticoduodenectomy: How I do it.

Background: Pancreaticoduodenectomy (PD) remains the standard approach for benign or malignant disease in the pancreatic head and periampullary regions. Despite attempts of diverse pancreatic anastomosis, no reliable pancreatic anastomosis has been recommended.

Methods: Between July 2023 to December 2023, a novel method of pancreaticogastrostomy (PG) using a stent bridging the remnant pancreas and the stomach were applied to drain the pancreatic juice into the gastric cavity in 12 consecutive open and laparoscopic cases. The surgical details and postoperative outcomes were analyzed to evaluate this method.

Results: The mean operation time was 318 ± 51.60 min. The mean time for the stent-bridging PG was 25.90 ± 4.86 min. No incidence of grades B or C postoperative pancreatic fistula (POPF) or anastomotic failure was occurred during the median follow-up period of 10.20 ± 1.55 months.

Conclusion: The stent-bridging PG had the advantages of safety, simplicity and promising efficacy by complete diversion of pancreatic juice and minimal manipulation of the pancreatic remnant under open or laparoscopic PD, proving its value as an alternative technique for mitigating the risk of POPF. By understanding the standardized procedures, surgeons can achieve consistent and reproducible results in complex pancreatic anastomosis. However, further evaluation with clinical trials is required to validate its real benefits.