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Updated: Jun 4, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Two-stage anastomotic reconstruction after pancreatectomy (TARP procedure) - A single-center retrospective case
Faik G Uzunoglu1, Victoria van Rüth1, Fiete Gehrisch1
1Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Background:
Venous congestion and small bowel edema after venous reconstruction during pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) may compromise anastomotic safety. A two-stage approach with delayed gastrointestinal reconstruction may offer a protective strategy. We refer to this concept as the TARP procedure (Two-stage Anastomotic Reconstruction after Pancreatectomy).
Materials And Methods:
This retrospective single-center study analyzed all consecutive patients who underwent TARP between February 2023 and February 2025. Tumor resection and venous reconstruction were completed in an initial operation, followed by deferred reconstruction within 24-72 h. Baseline characteristics and perioperative outcomes were analyzed descriptively.
Results:
Nine patients underwent TARP during the study period. The median age was 72 years and the primary indication for a two-stage reconstruction was small bowel edema due to venous congestion. Median operation time was 401 min, median ICU stay 9 days, and median hospital stay 28 days. No patient developed an anastomotic leak or clinically relevant postoperative pancreatic fistula. Six patients (66.7%) experienced Clavien-Dindo grade ≥ IIIb complications. One patient (11.1%) died within 30 days.
Conclusions:
Two-stage PD with delayed reconstruction appears to be a feasible approach in selected patients with intraoperative risk factors such as bowel edema or instability. Avoiding anastomosis under unfavorable conditions may reduce early morbidity.
