Pancreaticogastrostomy after pancreaticoduodenectomy using twin square wrapping with duct-to-mucosa anastomosis

Kosei Maemura, Yuko Mataki, Hiroshi Kurahara, Shinichiro Mori, Naotomo Higo, Masahiko Sakoda, Satoshi Iino, Akihiro Nakajo, Sumiya Ishigami, Shinichi Ueno, Sonshin Takao, Hiroyuki Shinchi, Shoji Natsugoe

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3 Citations (Scopus)


Background/Purpose: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreatic stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis [twin square wrapping (TSW) method]. Methods: Fifty-three patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and chronologically divided into a conventional group (n = 32) and a TSW group (n = 21). The perioperative factors and the postoperative outcomes were retrospectively analyzed. Results: The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume in the TSW group were lower than in the conventional group, but without a statistically significant difference. The TSW group had a significantly lower postoperative white blood cell count and C-reactive protein level, with a reduced intra-abdominal fluid accumulation as assessed by computed tomography on postoperative day 7, had a lower incidence of postoperative complications and pancreatic fistulas, and achieved a shorter duration of drain placement and shorter postoperative hospital stays as compared to the conventional group. Conclusions: The TSW technique should be considered for reducing pancreatic fistulas by diminishing the postoperative inflammatory response and improving patient outcomes without increasing the operating time.

Original languageEnglish
Pages (from-to)109-118
Number of pages10
JournalEuropean Surgical Research
Issue number1-2
Publication statusPublished - 23-08-2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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    Maemura, K., Mataki, Y., Kurahara, H., Mori, S., Higo, N., Sakoda, M., Iino, S., Nakajo, A., Ishigami, S., Ueno, S., Takao, S., Shinchi, H., & Natsugoe, S. (2015). Pancreaticogastrostomy after pancreaticoduodenectomy using twin square wrapping with duct-to-mucosa anastomosis. European Surgical Research, 55(1-2), 109-118.