International Surgery Journal | January 2017 | Vol 4 | Issue 1 Page 58 International Surgery Journal El-Badry AM et al. Int Surg J. 2017 Jan;4(1):58-63 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article Enveloped double purse-string versus conventional pancreatico- gastrostomy during Whipple procedure: comparative study at Sohag university onco-surgery program Ashraf M. El-Badry 1 *, Alaa A. Redwan 1 , Mohammad A. Abusedera 2 , Hitham M. Ali 3 INTRODUCTION Restoration of the connection between the pancreatic remnant and the digestive tract during whipple procedure (pancreatico-duodenectomy (PD)) remains as source of concern. 1 Anastomotic failure is associated with increased risk of postoperative complications, among which POPF is particularly troublesome. 2 Traditionally, pancreatico-enteric anastomosis was carried out by pancreatico-jejunsotomy (PJ). However, PG is theoritically less demanding and has lesser liability to ischemia and more protection to the anastomosis due to the acidic nature of the gastric secretion which prevents activation of the pancreatic enzymes. 3 The anatomical location of the stomach nearby the pancreatic remnant enables tension-free anastomosis. 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 ABSTRACT Background: Pancreatico-gastrostomy (PG) is widely applied for restoration of connection between the distal pancreatic remnant and digestive tract during Whipple procedure. Comparative studies on the clinical outcome of various PG techniques are scarce. Methods: Medical records of patients who underwent PG at Sohag University Hospital (November 2012-December 2015) were reviewed. Patients who had PG using our new technique of enveloped double purse-string sutures (EDPS- PG) were compared with control group of conventional transfixing suture PG regarding the postoperative outcome. Results: Twenty-seven patients (18 conventional PG and 9 EDPS-PG) were enrolled. Grade C postoperative pancreatic fistula (POPF) occurred only in the conventional PG group. Patients in the EDPS-PG group needed significantly shorter time before removal of the abdominal drains (p = 0.04), significantly reduced length of hospital stay (p = 0.03) and significantly lower grades of postoperative complications (p = 0.02) compared with the conventional PG group. Postoperative death occurred only in one patient in the control group. No significant difference could be found regarding operative time, postoperative bleeding delayed gastric emptying or bile leak. Conclusions: EDPS-PG is new, simple and safe technique for PG during Whipple procedure and results in significant reduction of POPF and overall complications. Keywords: Pancreatico-gastrostomy, Pancreatictomy, Whipple 1 Department of General Surgery, 2 Department of Radiology, 3 Departemnt of Anesthesia and Intensive Care, Sohag University Hospital, Faculty of Medicine, Sohag University, Sohag, Egypt Received: 02 November 2016 Accepted: 07 November 2016 *Correspondence: Dr. Ashraf Mohammad El-Badry, E-mail: ashraf.elbadry@med.sohag.edu.eg Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20164052