Late reoperative surgery after laparoscopic pancreaticoduodenectomy: A novel pancreaticogastrostomy

Purpose: Minimal-invasive pancreaticoduodenectomy has become an established procedure for pancreatic head tumors. Local recurrence or anastomotic stricture requiring reoperation is uncommon, and no standardized approach exists for re-anastomosis of the pancreatic remnant. This article demonstrates a novel modified locking technique of Blumgart pancreaticogastrostomy applied during re-laparoscopy. Methods: The locking Blumgart pancreaticogastrostomy was performed in four layers: the posterior pancreatic stump-to-stomach layer, the posterior and lateral pancreatic duct-to-gastric mucosa layer, the anterior pancreatic duct-to-gastric mucosa layer, and the anterior pancreatic stump-to-stomach layer. Results: Three cases of the pancreatogastric anastomosis procedure were carried out. No postoperative pancreatic fistula occurred, with no incidence of pancreatogastric anastomotic stricture observed during follow-up. The technical rationale of this anastomotic approach include: 1) avoidance of resection of the original afferent jejunal limb, 2) a more physiological mucosa-to-mucosa adaptation between the pancreatic duct and gastric wall, and 3) use of a locking mattress suture to achieve more complete hemostasis, and 4) separate suturing of the anterior/posterior and lateral walls of both the pancreatic duct and gastric mucosa. Conclusions: The modified locking Blumgart pancreaticogastrostomy is technically feasible and demonstrates preliminary safety in reoperative surgery for late local tumor recurrence or anastomotic stricture at the pancreaticojejunal site following minimal-invasive pancreaticoduodenectomy.