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. 2025 May 17;410(1):163.
doi: 10.1007/s00423-025-03738-0.

A simplified stent-bridging pancreaticogastrostomy during pancreaticoduodenectomy: How I do it

Yan Sun #  1 , Zheng Wang #  1 , Kaixuan Li  1 , Longchang Chen  1 , Junpeng Wang  1 , Liuxin Duan  2 , Quanda Liu  3
Affiliations

A simplified stent-bridging pancreaticogastrostomy during pancreaticoduodenectomy: How I do it

Yan Sun et al. Langenbecks Arch Surg. .

Abstract

Background: Pancreaticoduodenectomy (PD) remains the standard approach for benign or malignant disease in the pancreatic head and periampullary regions. Despite attempts of diverse pancreatic anastomosis, no reliable pancreatic anastomosis has been recommended.

Methods: Between July 2023 to December 2023, a novel method of pancreaticogastrostomy (PG) using a stent bridging the remnant pancreas and the stomach were applied to drain the pancreatic juice into the gastric cavity in 12 consecutive open and laparoscopic cases. The surgical details and postoperative outcomes were analyzed to evaluate this method.

Results: The mean operation time was 318 ± 51.60 min. The mean time for the stent-bridging PG was 25.90 ± 4.86 min. No incidence of grades B or C postoperative pancreatic fistula (POPF) or anastomotic failure was occurred during the median follow-up period of 10.20 ± 1.55 months.

Conclusion: The stent-bridging PG had the advantages of safety, simplicity and promising efficacy by complete diversion of pancreatic juice and minimal manipulation of the pancreatic remnant under open or laparoscopic PD, proving its value as an alternative technique for mitigating the risk of POPF. By understanding the standardized procedures, surgeons can achieve consistent and reproducible results in complex pancreatic anastomosis. However, further evaluation with clinical trials is required to validate its real benefits.

Keywords: Pancreatic anastomosis; Pancreaticoduodenectomy; Pancreaticogastrostomy; Postoperative pancreatic fistula; Stent-bridging.

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Conflict of interest statement

Declarations. Ethical approval: This study was reviewed and approved by the Ethics Committee of Guang’anmen Hospital (approval no. 2023-022-KY-01), and informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Laparoscopic stent-bridging PG. a The Wirsung duct was cannulated with a compatible polyethylene catheter as stent (black arrow). b Continuous suture of the whole pancreatic stump (black asterisk) was performed. c The stump of the gastroduodenal artery and pancreatic stump were wrapped using the falciform ligament and round ligament. d A point-like full-layer hole by electrocoagulation (white arrow) matching the position of the Wirsung duct was made on the posterior wall of the stomach. e Only the compatible polyethylene catheter (black arrow) was inserted into the gastric lumen. f Two seromuscular purse-string sutures were applied around the incision for fixation and the gastric lumen was gently pulled closely adjacent to the pancreatic remnant. g The omental flap, along with portions of the preperitoneal fat, was localized and two easy-flow drains were placed in the proximity of the pancreatic and biliary anastomoses. h The postoperative CT scan confirmed optimal positioning and secure fixation of the stent, with no evidence of specific abnormalities around the anastomosis. Compatible polyethylene catheter (black arrow); pancreatic stump (black asterisk); point-like electrocoagulation (white arrow)
Fig. 2
Fig. 2
Open stent-bridging PG follows a standardized procedure akin to a laparoscopic approach
See this image and copyright information in PMC

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