Simpler and safer anastomosis by pancreaticogastrostomy using a linear stapler after pancreaticoduodenectomy

Postoperative pancreatic fistula (POPF) remains a major and serious problem after pancreaticoduodenectomy (PD). In its presence, pancreatic juice may leak from the main duct or branches of the pancreatic stump. To prevent this, we have applied a newly modified anastomosis of pancreaticogastrostomy (PG) using a linear stapler (stapled PG). Clinical records of 30 consecutive patients who underwent PD were reviewed between 2013 and 2023 at our community hospital. Regarding procedures, 12 stapled PGs and eighteen pancreaticojejunostomies (PJs) were performed after PD, from 2018 to 2023 and from 2013 to 2017, respectively. The pancreas was transected for long compression by a linear stapler, involving: pre-compression for 5 min, stapling for 5 min, and dissection for 5 min. After removal of the staples at the main duct opening of the pancreatic stump, PG anastomosis was performed. The outer layer was anastomosed by a straight single row pancreas-transfixing suture with the posterior gastric wall, and inner layer duct-to-mucosa anastomosis was also performed in a radial axis manner. Anastomosis of PJ was conducted without using a linear stapler. POPF was defined as a clinical manifestation of POPF (grade B/C) based on the ISGPF (International Study Group of Pancreatic Fistula) criteria. None of the 12 patients who had undergone stapled PG developed clinically relevant POPF, whereas 5 (27%) patients who had received PJ developed POPF. Three patients showed POPF grade B and 2 patients exhibited POPF grade C. Stapled PG after PD may reduce clinically relevant POPF. Because our sample size was small, the further accumulation of cases is required to validate this method.