Feasibility and safety of "bridging" pancreaticogastrostomy for pancreatic trauma in Landrace pigs

Abstract

Background: In recent years, we created and employed a new anastomosis method, "bridging" pancreaticogastrostomy, to treat patients with extremely severe pancreatic injury. This surgery has advantages such as short length of surgery, low secondary trauma, rapid construction of shunts for pancreatic fluid, preventing second surgeries, and achieving good treatment outcomes in clinical practice. However, due to the limited number of clinical cases, there is a lack of strong evidence to support the feasibility and safety of this surgical procedure. Therefore, we carried out animal experiments to examine this procedure, which is reported here.

Aim: To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy, "bridging" pancreaticogastrostomy.

Methods: Ten Landrace pigs were randomized into the experimental and control groups, with five pigs in each group. "Bridging" pancreaticogastrostomy was performed in the experimental group, while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group. After surgery, the general condition, amylase levels in drainage fluid on Days 1, 3, 5, and 7, fasting and 2-h postprandial blood glucose 6 mo after surgery, fasting, 2-h postprandial peripheral blood insulin, and portal vein blood insulin 6 mo after surgery were assessed. Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.

Results: After surgery, the general condition of the animals was good. One in the control group did not gain weight 6 mo after surgery, whereas significant weight gain was present in the others. There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7. There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups. One month after surgery, the sinus tract orifice/anastomosis was patent in the two groups. Six months after surgery, the sinus tract orifice/anastomosis was sealed, and pancreases in both groups presented with chronic pancreatitis.

Conclusion: "Bridging" pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.

Keywords: Damage control surgery; Pancreatic trauma; Safety; Severe pancreatic injury; “Bridging” pancreaticogastrostomy.

Figure 1

Preparation of pancreatic stumps in all animals in the study.

Figure 2

”Bridging“ pancreaticogastrostomy was performed in the experimental group. The distance between the pancreatic stump and the stomach was approximately 2 cm.

Figure 3

Routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group.

Figure 4

Sinus tract between the pancreas and stomach. Orange arrows showed the sinus tract between the pancreas and stomach 1 mo after “bridging” pancreaticogastrostomy. Black arrows showed the sinus tract opening in the stomach.

Figure 5

Tight connection between the pancreas and stomach. A: Orange arrows show the tight connection between the pancreas and stomach after routine mucosa-to-mucosa pancreaticogastrostomy; B: Black arrows show the anastomosis.

Figure 6

Significantly dilated pancreatic duct.

Figure 7

The pancreas was filled with large amounts of fibrous tissues and acinar atrophy with a drastic decrease in acinar cells and pancreatic islets. A: × 100; B: × 400.