The Vertical Array Reconstruction Technique in Pylorus-Preserving Pancreatoduodenectomy.

Kobayashi, Shinjiro; Koizumi, Satoshi; Hatori, Takashi; Segami, Kouhei; Hoshino, Hiroyuki; Otsubo, Takehito

BACKGROUND/AIMS We describe a new reconstruction method of duodenojejunal anastomosis, the "vertical array reconstruction" (VAR) technique, following pylorus-preserving pancreatoduodenectomy (PPPD). METHODS The VAR technique aligns the stomach, duodenum, and jejunal loop vertically along the body's longitudinal axis. It was performed in 120 consecutive patients (between June 2008 and October 2015) who underwent PPPD. We evaluated the incidence of delayed gastric emptying (DGE). RESULTS The incidence of DGE was 1.7% (n = 2). The proposed clinical grading classified these 2 cases of DGE as grade B. There was no DGE related to pancreatic fistula. The median duration to starting a solid diet was 3 days (range 3-5 days). The median operative time was 450 min (range 391-550 min). CONCLUSION The VAR technique allows the upper digestive tract to be aligned linearly and can minimize the risk of DGE after PPPD.