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. 2021 Jul 11;10(14):3064.
doi: 10.3390/jcm10143064.

Modified Technique for Wirsung-Pancreatogastric Anastomosis after Pancreatoduodenectomy: A Single Center Experience and Systematic Review of the Literature

Cinzia Bizzoca  1 , Salvatore Fedele  2 , Anna Stella Lippolis  3 , Fabrizio Aquilino  2 , Marco Castellana  4 , Maria Raffaella Basile  3 , Giuseppe Lucarelli  5 , Leonardo Vincenti  1
Affiliations

Modified Technique for Wirsung-Pancreatogastric Anastomosis after Pancreatoduodenectomy: A Single Center Experience and Systematic Review of the Literature

Cinzia Bizzoca et al. J Clin Med. .

Abstract

Background: The mortality rate following pancreaticoduodenectomy (PD) has been decreasing over the past few years; nonetheless, the morbidity rate remains elevated. The most common complications after PD are post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) syndrome. The issue as to which is the best reconstruction method for the treatment of the pancreatic remnant after PD is still a matter of debate. The aim of this study was to retrospectively analyze the morbidity rate in 100 consecutive PD reconstructed with Wirsung-Pancreato-Gastro-Anastomosis (WPGA), performed by a single surgeon applying a personal modification of the pancreatic reconstruction technique.

Methods: During an 8-year period (May 2012 to March 2020), 100 consecutive patients underwent PD reconstructed with WPGA. The series included 57 males and 43 females (M/F 1.32), with a mean age of 68 (range 41-86) years. The 90-day morbidity and mortality were retrospectively analyzed. Additionally, a systematic review was conducted, comparing our technique with the existing literature on the topic.

Results: We observed eight cases of clinically relevant POPF (8%), three cases of "primary" DGE (3%) and four patients suffering "secondary" DGE. The surgical morbidity and mortality rate were 26% and 6%, respectively. The median hospital stay was 13.6 days. The systematic review of the literature confirmed the originality of our modified technique for Wirsung-Pancreato-Gastro-Anastomosis.

Conclusions: Our modified double-layer WPGA is associated with a very low incidence of POPF and DGE. Also, the technique avoids the risk of acute hemorrhage of the pancreatic parenchyma.

Keywords: pancreatic cancer; pancreatic surgery; pancreaticoduodenectomy; wirsung-pancreatogastric anastomosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) The seromuscular incision on the posterior gastric wall (a) is slightly larger than the greatest diameter of the pancreatic stump (b). The catheter used as external stent (c) is introduced into the Wirsung duct to ensure its patency during anastomosis (B) The suture between the anterior pancreatic surface and the gastric seromuscular layer is performed. Then, the duct-to-mucosa anastomosis is performed, applying one or more stitches in each quadrant (C) After the anastomosis between the posterior gastric wall and the pancreatic stump is completed, the catheter is secured to the anterior gastric seromuscular layer (d) and exteriorized through the anterior abdominal wall (e).
Figure 2
Figure 2
Flowchart of the systematic review. WPGA Wirsung-Pancreato-Gastro-Anastomosis; PGA Pancreatogastric Anastomosis; PJA Pancreatico-Jejunal Anastomosis.
See this image and copyright information in PMC

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