Development of a Novel Dorsal Incision Only Invagination Type Pancreatogastrostomy (Charité-PG) Following Open Pancreaticoduodenectomy—A Single Centre Experience

Abstract

The implementation of a pancreatico-enteric anastomosis following open single stage pancreaticoduodenectomy (PD) is still associated with the most threatening complications in modern pancreatic surgery, such as postoperative pancreatic fistula (POPF), postpancreatectomy haemorrhage (PPH), delayed gastric emptying (DGE), intraabdominal abscesses and related mortality. With this study, we introduce Charite-PG, a new dorsal incision only invagination type pancreatogastrostomy (dioPG) for the restoration of the pancreatic remnant following PD, and compare it to a PG requiring ventral gastrotomy (vgPG). A total of 49 consecutive patients, who underwent reconstruction via dioPG, and 92 consecutive patients, who underwent restoration via vgPG, were identified from our prospective database and further reviewed for perioperative parameters, complication rates, mortality and follow-up. The percentage of overall complications (p = 0.301), as well as the 30-day mortality rate (p = 0.725) and survival (p = 0.543), were comparable in both groups. The operation time in the dioPG group was significantly shorter (p = 0.04), and patients in this group developed substantially fewer rates of DGE (p = 0.036). We provide a feasible and safe technique for restoration following PD via our novel dioPG, causing fewer cases of DGE. Nevertheless, pancreatico-enteric anastomoses require expertise and experience.