Pancreatogastrostomy is a common alternative to pancreatojejunostomy [1, 2, 3, 4]. Anastomosis of the pancreatic remnant with the stomach was first described in 1946 [5] and refined in the 1980s.
Pancreatogastrostomy offers the following benefits:
- Close anatomical relation of the posterior gastric wall with the pancreas
- low risk of gastric ischemia
- easy access to the anastomosis by gastroscopy
- Easy decompression of the anastomosis via the gastric tube
- Anastomosis of even large-caliber pancreatic remnants [6, 7].
As a reconstruction procedure, pancreatogastrostomy results in pancreatic fistula rates of less than 2.5% [4, 7, 8, 9]. Complications also include bleeding at the anastomosis, which can be well controlled by adequate management of postoperative complications [4, 7, 8, 10]. Overgrowth of the pancreatogastrostomy by gastric mucosa resulting in anastomotic stenosis has been described [11, 12, 13].
A number of variant techniques have been published for pancreatogastrostomy:
- Invagination or "duct to mucosa" [14].
- Suture technique - purse-string suture or transpancreatic mattress suture [10, 15].
- Access to the posterior gastric wall via anterior gastrotomy [16].
There are numerous observational studies, some meta-analyses, and randomized controlled trials [17-31] addressing the issue which anastomosis technique – pancreatojejunostomy or pancreatogastrostomy – is better in terms of morbidity and mortality. Conclusion: At present, there is insufficient evidence for clear superiority of either anastomosis technique.