Pancreatogastrostomy is a commonly used alternative to pancreaticojejunostomy [1, 2, 3, 4]. The anastomosis of the pancreatic remnant with the stomach was first described in 1946 [5] and further developed in the 1980s.
Pancreatogastrostomy has the following advantages:
- close anatomical proximity of the posterior gastric wall and pancreas
- low ischemic risk of the stomach
- easy accessibility of the anastomosis via gastroscopy
- easy pressure relief of the anastomosis through a gastric tube
- anastomosis of even large-caliber pancreatic remnants [6, 7]
With pancreatogastrostomy as a reconstruction procedure, pancreatic fistula rates of less than 2.5% are achieved [4, 7, 8, 9]. Complications also include bleeding in the anastomosis area, which can be well managed with adequate postoperative complication management [4, 7, 8, 10]. Overgrowth of the pancreatogastrostomy by gastric mucosa with resulting anastomotic stenosis has been described [11, 12, 13].
There are various technical variants for the technique of 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]
Regarding the question of which anastomosis technique - pancreaticojejunostomy or pancreatogastrostomy - is superior in terms of morbidity and mortality, there are numerous observational studies, some meta-analyses, and randomized controlled trials [17 – 31]. Conclusion: Currently, there is no sufficient evidence for the clear superiority of either anastomosis technique.