Buttressed pancreaticogastrostomy for a soft pancreas and/or small pancreatic duct in pancreaticoduodenectomy: A retrospective cohort study

Abstract Objective Post‐operative pancreatic fistula (POPF) has a major impact on the post‐operative outcomes after pancreaticoduodenectomy (PD). Soft pancreas and small pancreatic duct diameter are major risk factors for POPF. In this study, we aimed to evaluate the short‐term outcomes of our technique of buttressed pancreaticogastrostomy (PG) as a method of pancreatic anastomosis. Patients and Methods A retrospective cohort study was conducted on patients who underwent PD with a soft pancreas and/or small pancreatic duct diameter ≤5 mm. The study period spanned from January 2018 to December 2022. Results A total of 69 patients were included in the study, comprising 30 females and 39 males. The mean age of the patients was 57 ± 14.3 years. The mean operative time of the whole procedure was 335 ± 43.7 min and that of buttressed PG was 22 ± 4.6 min. Two patients had early post‐operative bleeding. Only 5 (7.24%) patients developed a grade A POPF. Eight (11.8%) patients had delayed gastric emptying. Conclusion Buttressing PG represents a simple and safe reconstruction technique following PD, particularly for patients with a soft pancreas and/or small pancreatic duct. This approach is associated with a low incidence of POPF. However, prospective randomised trials with large sample sizes are required to confirm these results.