Application of Simplified Stent-bridging Pancreaticogastrostomy in Open Pancreaticoduodenectomy

The standardized technique for pancreatic anastomosis in pancreaticoduodenectomy (PD) has not achieved consistent acceptance due to persistent technical complexity and the incidence of postoperative pancreatic fistula (POPF). This paper presents a case in which a simplified stent-bridging pancreaticogastrostomy (PG) is employed. The patient is placed in the supine position, and a longitudinal midline abdominal incision is made. Following a subtotal stomach-preserving PD, reconstruction is performed. An appropriately sized polyethylene catheter is inserted to bridge the Wirsung duct and the stomach, enabling drainage of pancreatic juice into the gastric cavity. The entire pancreatic stump is continuously sutured. The Wirsung duct and the polyethylene catheter are looped and ligated. Two discontinuous figure-of-eight sutures are prearranged without knotting, and an incision is made in the posterior gastric wall. The distal end of the polyethylene catheter is inserted into the gastric cavity to provide internal drainage. Two seromuscular purse-string sutures are tightened to approximate the pancreatic remnant to the gastric lumen. The gastric omentum with adjacent preperitoneal fat is positioned over the anastomosis site. The procedural steps of the stent-bridging PG are described in detail to demonstrate technical feasibility. By diverting pancreatic fluid and limiting manipulation of the remaining pancreatic tissue, the technique is intended to reduce mechanical stress at the anastomosis. Further experience is required to clarify optimal indications and long-term outcomes.