Trans-gastric pancreaticogastrostomy reconstruction after pylorus-preserving robotic Whipple: a proposal for a standardized technique.
BACKGROUND
A number of technical improvements regarding the pancreatic anastomosis have decreased the morbidity and mortality after pancreaticoduodenectomy. However, postoperative pancreatic fistula (POPF) remains is the most feared complication, and the ideal technique for pancreatic reconstruction is undetermined.


MATERIALS AND METHODS
This study is a retrospective review of a prospectively maintained database. Data were collected from all consecutive robot-assisted pancreaticoduodenectomies (RAPD), performed by a single surgeon, at the University of Illinois Hospital & Health Sciences System, between September 2007 and January 2016.


RESULTS
A total of 28 consecutive patients (16 male and 12 female) who underwent a RAPD were included in this study. Patients had a mean age and mean BMI of 61.5 years (SD = 12.3) and 27 kg/m2 (SD = 4.9), respectively. The mean operative time was 468.2 min (SD = 73.7) and the average estimated blood loss was 216.1 ml (SD = 113.1). The mean length of hospitalization was 13.1 days (SD = 5.4). There was no clinically significant POPF registered.


CONCLUSION
Trans-gastric pancreaticogastrostomy (TPG) represents a valid and feasible option as a pancreatic digestive reconstruction during RAPD. Initial results showed decreased incidence of POPF with an increased risk of postoperative bleeding. Our experience suggests that TPG might be safer than pancreaticojejunostomy (PJ); further studies are needed in order to confirm.
['Giulianotti|Pier C|PC|', 'Gonzalez-Heredia|Raquel|R|0000-0002-9406-2848', 'Esposito|Sofia|S|', 'Masrur|Mario|M|', 'Gangemi|Antonio|A|', 'Bianco|Francesco M|FM|']
D000328:Adult D000368:Aged D000714:Anastomosis, Surgical D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D017063:Outcome Assessment, Health Care D010179:Pancreas D016577:Pancreaticoduodenectomy D011183:Postoperative Complications D011708:Pylorus D019651:Reconstructive Surgical Procedures D012189:Retrospective Studies D012307:Risk Factors D065287:Robotic Surgical Procedures D013270:Stomach
Whipple Pancreaticoduodenectomy POPF Dunking Pancreatic digestive anastomosis Robotic-assisted