Applying refined pancreaticogastrostomy techniques in pancreatic trauma

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.