Transgastric pancreaticogastric anastomosis: An alternative operative approach for middle pancreatectomy

Objective: To determine short-term outcomes following middle pancreatectomy with transgastric pancreaticogastric anastomosis. Design, Setting, and Patients: A retrospective analysis of 23 patients who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis at the Massachusetts General Hospital, Boston, from June 22, 2005, through April 29, 2009. Main Outcome Measures: Indications for procedure, operative time, length of stay, morbidity, mortality, and need for readmission, antibiotics, reoperation, additional procedures, or transfusion. Results: The mean age of 15 women and 8 men who underwent middle pancreatectomy with transgastric pancreaticogastric anastomosis was 55.0 years. The median follow-up time was 12.9 months. The most commonly resected tumors were intraductal papillary mucinous neoplasms (n=9), serous cystadenomas (n=5), and neuroendocrine tumors (n=4). The mean (SD) operative time was 191 (39) minutes. No patients required intraoperative transfusion. The median hospital stay was 5 days. The mostcommoncomplications were pancreatic fistula (n=6), intra-abdominal abscess (n=4), and superficial skin infection (n=4). Three patients had splenic artery pseudoaneurysms. Seven patients required readmission; 2 required reoperation. No patients developed postoperative new or worsening endocrine or exocrine insufficiency. There were no deaths. Conclusions: Middle pancreatectomy with transgastric pancreaticogastric anastomosis offers a safe alternative to the traditional Roux-en-y pancreaticojejunostomy and may be technically simpler.