90th Annual Meeting Abstracts
Transgastric pancreatogastric anastomosis: An alternative operative approach for middle pancreatectomy
*Jennifer LaFemina, MD, *Deborah McGrath, RN, Andrew L. Warshaw, MD, Carlos Fernandez-del Castillo, MD
Massachusetts General Hospital, Boston, MA
Objective: Middle pancreatectomy (MP) allows for a limited resection of small, benign, or low-grade malignant tumors of the pancreatic neck or proximal body. It serves as an alternative to an extended distal pancreatectomy that preserves exocrine and endocrine function as well as the spleen. These resections have traditionally included Roux-en-y pancreatojejunal anastomoses. Transgastric pancreatogastric anastomosis has been described in the reconstruction following a Whipple procedure. We have introduced this as an alternative approach in MP that is technically less complex. The current study aims to determine short-term outcomes following this procedure.
Design: Retrospective analysis.
Setting: Quaternary referral center.
Patients: 22 patients who underwent MP with transgastric pancreatogastric anastomosis between June 2005 and April 2009.
Main Outcome Measures: Indications for procedure, operative time, length of stay, mortality, and need for readmission, antibiotics, reoperation, additional procedures, or transfusion.
Results: The average age of 15 females and 7 males who underwent MP with transgastric pancreatogastric anastomosis was 54.5 years. Median follow-up time was 9.8 mo. The most commonly resected tumors were IPMNs (N=8), followed by serous cystadenomas (N=6) and neuroendocrine tumors (N=4). Additional lesions included solid pseudopapillary neoplasm (N=1), simple cyst (N=1), chronic pancreatitis (N=1), and IPMN with synchronous neuroendocrine tumor (N=1). Mean operative time was 191 min +/- 40 min, and no patients required intraoperative transfusion. Median hospital stay was 5 days. The most common complications were pancreatic fistula (N=6, 27%), abdominal abscess (N=3), and superficial skin infection (N=3). Four patients required readmission. No patients needed a reoperation, and there were no deaths.
Conclusions: MP with transgastric pancreatogastric anastomosis offers a safe alternative to the traditional Roux-en-y pancreatojejunostomy and may be technically simpler.