Abstract
Despite the evaluation of various improvised procedures, pancreatic leakage persists as a complication after pancreaticoduodenectomy (PD). Pancreaticoenteric reconstruction after PD is mainly achieved with either pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG), and many surgical centers adopt PG because anastomotic leakage is generally observed less frequently after PG than after PJ. However, pancreaticodigestive anastomotic stricture sometimes develops after PD with PG. Patency of the pancreaticoenterostomy is one of the most important factors affecting the function of the remnant pancreas and quality of life. Anastomotic stenosis after PG is attributed to acute inflammation and fibrosis around the anastomosis. We agree that duct-to-mucosa anastomosis is preferable in PG; however, it is not always easy to perform duct-to-mucosa anastomosis in the case of soft pancreas when the diameter of the pancreatic duct is small. Therefore, we use implantation of pancreatic stents in PG for soft pancreas with a small diameter pancreatic duct. On the other hand, pylorus-preserving pancreaticoduodenectomy (PPPD) reduces the incidence of post-gastrectomy syndrome (postprandial dumping, diarrhea, dyspepsia, nausea, and vomiting) following standard PD and yields better functional results. However, delayed gastric emptying (DGE) is one of the most troublesome complications of this procedure, which impairs patient recovery and prolongs the hospital stay after the surgery. Therefore, we developed a new technique, namely, “vertical stomach reconstruction with PG after Oida‘s modified subtotal stomach-preserving pancre-aticoduodenectomy (SSPPD)” to prevent DGE and were able to reduce the incidence of DGE. We review the relationship of DGE and pancreatic duct patency following PD with PG and present our SSPPD.
