Inframesocolic pancreatic anastomosis after pancreatoduodenectomy: description and initial experience with a novel technique.

Background: Pancreatoduodenectomy (PD) is one of the most challenging surgical procedures among abdominal surgeries. The most common complication after PD is postoperative pancreatic fistula (POPF), which can be severe and entail other complications, such as post-pancreatectomy hemorrhage (PPH), which can be fatal. Several surgical techniques have been proposed to reduce the incidence of POPF and PPH.

Methods: In this study, we describe inframesocolic pancreatic anastomosis, which involves segregating the pancreatic anastomosis into the inframesocolic area by mobilizing the pancreatic remnant and creating a small window into the transverse mesocolon.

Results: This surgical technique was performed in 17 patients, with promising results in terms of delayed PPH prevention. In particular, we had only one case of PPH that was successfully treated by placing a stent into the SMA. No other bleeding events were reported, even in cases of anastomotic leakage.

Conclusions: In the context of mitigation strategies, this technique might be efficient in reducing the incidence of delayed PPH due to leakage of pancreatic juice into the supramesocolic area and consequent vascular erosion.