Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 521-524
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.521
Applying refined pancreaticogastrostomy techniques in pancreatic trauma
Jake Krige, Marc Bernon, Eduard Jonas
Jake Krige, Marc Bernon, Eduard Jonas, Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town 7925, South Africa
Author contributions: Krige J, Bernon M and Jonas E have contributed equally to the writing of this letter to the editor and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eduard Jonas, MBChB, PhD, Professor, Department of Surgery, University of Cape Town Health Sciences Faculty, Anzio Road, Cape Town 7925, South Africa. eduard.jonas@uct.ac.za
Received: July 31, 2021
Peer-review started: July 31, 2021
First decision: October 3, 2021
Revised: November 10, 2021
Accepted: April 29, 2022
Article in press: April 29, 2022
Published online: May 27, 2022
Processing time: 297 Days and 13.2 Hours
Abstract

We comment on a study titled “Feasibility and safety of "bridging" pancreaticogastrostomy for pancreatic trauma in Landrace pigs” in which ten pigs were randomized to either experimental “bridging” pancreaticogastrostomy (PG) or a control group with a routine mucosa-to-mucosa PG. At six months anastomoses had strictured and closed in both groups. The authors concluded that “bridging” PG is feasible and safe in damage control surgery during the early stage of pancreatic injury. In this letter we comment on the study design, specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma centre. Our data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.

Keywords: Pancreatic trauma; Pancreatic anastomoses; Pancreaticogastrostomy; Complications

Core Tip: In the elective setting a number of different pancreatic anastomotic methods have been proposed with variations in the site of implantation (stomach or jejunum), the anastomotic technique and the use of pancreatic duct stenting. These techniques need to be adapted to the prevailing operative circumstances. We recommend a pancreaticogastrostomy rather than a pancreaticojejunostomy in the presence of severe shock, prolonged resuscitation and associated major vascular injuries. We routinely use a 5 Fr silastic intraluminal pancreatic duct stent through the anastomoses.