Basic Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2021; 13(5): 419-428
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.419
Feasibility and safety of “bridging” pancreaticogastrostomy for pancreatic trauma in Landrace pigs
Jian Feng, Hang-Yu Zhang, Li Yan, Zi-Man Zhu, Bin Liang, Peng-Fei Wang, Xiang-Qian Zhao, Yong-Liang Chen
Jian Feng, Department of Hepatopancreatobiliary Surgery, Peking University Shougang Hospital, Beijing 100144, China
Jian Feng, Hang-Yu Zhang, Li Yan, Zi-Man Zhu, Bin Liang, Peng-Fei Wang, Xiang-Qian Zhao, Yong-Liang Chen, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepetobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Chen YL is the guarantor of the integrity of the entire study, carried out the study design, defined the intellectual content, participated in the literature research, and reviewed the manuscript; Feng J, Zhang HY, and Yan L performed the research, wrote the first draft, and analyzed the data; Zhu ZM, Liang B, Wang PF, and Zhao XQ assisted in animal experiments and acquired data; Zhang HY and Yan L are considered co-first author; All authors read and approved the final manuscript.
Institutional animal care and use committee statement: The operational procedures for the animal experiments were approved by the Institutional Animal Care and Use Committee (IACUC) of PLA General Hospital.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
ARRIVE guidelines statement: The authors have read the ARRIVE Guidelines, and the manuscript was prepared and revised according to the ARRIVE Guidelines.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Liang Chen, MD, PhD, Director, Doctor, Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepetobiliary Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. chenyongl301@163.com
Received: January 12, 2021
Peer-review started: January 12, 2021
First decision: February 14, 2021
Revised: February 19, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: May 27, 2021
Abstract
BACKGROUND

In recent years, we created and employed a new anastomosis method, “bridging” pancreaticogastrostomy, to treat patients with extremely severe pancreatic injury. This surgery has advantages such as short length of surgery, low secondary trauma, rapid construction of shunts for pancreatic fluid, preventing second surgeries, and achieving good treatment outcomes in clinical practice. However, due to the limited number of clinical cases, there is a lack of strong evidence to support the feasibility and safety of this surgical procedure. Therefore, we carried out animal experiments to examine this procedure, which is reported here.

AIM

To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy, “bridging” pancreaticogastrostomy.

METHODS

Ten Landrace pigs were randomized into the experimental and control groups, with five pigs in each group. “Bridging” pancreaticogastrostomy was performed in the experimental group, while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group. After surgery, the general condition, amylase levels in drainage fluid on Days 1, 3, 5, and 7, fasting and 2-h postprandial blood glucose 6 mo after surgery, fasting, 2-h postprandial peripheral blood insulin, and portal vein blood insulin 6 mo after surgery were assessed. Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.

RESULTS

After surgery, the general condition of the animals was good. One in the control group did not gain weight 6 mo after surgery, whereas significant weight gain was present in the others. There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7. There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups. One month after surgery, the sinus tract orifice/anastomosis was patent in the two groups. Six months after surgery, the sinus tract orifice/anastomosis was sealed, and pancreases in both groups presented with chronic pancreatitis.

CONCLUSION

“Bridging” pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.

Keywords: Pancreatic trauma, Damage control surgery, “Bridging” pancreaticogastrostomy, Severe pancreatic injury, Safety

Core Tip: This is a basic experimental research paper on the damage control surgery for pancreatic trauma, "bridging" pancreaticogastrostomy. To examine the feasibility and safety of this technique in Landrace pigs, we designed a series of research experiments. We found “bridging” pancreaticogastrostomy can be used to establish rapidly a channel and has similar short- and long-term results compared with the routine mucosa-mucosa pancreaticogastrostomy.