Double Purse-String Telescoped Pancreaticogastrostomy: An Expedient, Safe, and Easy Technique

Cephalic Duodeno-Pancreatectomy with Pancreatic-Gastric Anastomosis with Double Purse String, in Patient with Lithiasis and Tumoral Jaundice - Case Report

“…Thus, Addeo reports a rate of 8% of pancreatic fistulas [18], Bartsch 8.6% [17] 2.2% Zhu [19] and Peng 0% [17].…”

“…A procedure similar to that described by Peng was published in 2013 by Addeo et al In this alternative the technique used was the placement of 2 purse string threads to the gastric posterior seromuscular layer and one purse string to the gastric posterior mucosal layer. [18]. Zhu et al describe a technique similar to that published by Peng, in which the two threads in purse string from the seromuscular and gastric mucosa and are applied through the posterior gastric approach [19].…”

Enveloped double purse-string versus conventional pancreatico-gastrostomy during Whipple procedure: comparative study at Sohag university onco-surgery program

“…4 Tailoring the extent of posterior gastrostomy incision according to that of the pancreatic stump facilitates sufficient invagination of the pancreatic remnant inside the stomach and eliminates the problem of discrepancy between the size of the pancreatic remnant and the jejunal circumference that PG was introduced clinically by Waugh and Clagett in and evolved through several modifications. [6][7][8][9][10][11][12] Clinical studies during the ninties and almost the first decade of the current century showed that the incidence of postoperative complications, including POPF, after application of PJ versus PG were not significantly different. [13][14][15] However, more recent data provide clear evidence that PG is superior to PJ in terms of reduction of postoperative complication rates, principally the incidence of POPF.…”

“…The telescoped pancreatic remnant is fixed by tying two external seromuscular purse-string sutures in the 9 o'clock position around the posterior gastrostomy. 10 Despite the wide range of PG techniques, none has combined the use of purse-string and transfixing sutures to ensure better fixation of the telescoped pancreas. Moreover, the current literature contains no comparative studies on the outcome of various PG procedures.…”

“…In comparison with Addeo a et al who placed the ties of double external PS sutures only in the 9 o'clock position, our strategy of tying the PS sutures in opposite direction of 180 degrees angle (3 and 9 o'clock positions) provides further support of the pancreatic stump inside the gastric sleeve. 10 This is particularly substantial for securing the PG in case of soft pancreatic parenchyma. Furthermore, the addition of anterior and posterior rows of transfixing sutures provides strong envelop around the PS sutures to further stabilize the pancreatico-gastric anastomosis.…”