Double Gastric Hanging for Gastric Exposure in Laparoscopic Distal Pancreatectomy

Abstract

Background: Gastric traction is essential in laparoscopic distal pancreatic resections. We already described the single gastric hanging providing good exposure on the left pancreas and we herein introduce a modification named the double gastric hanging. Methods: The double gastric hanging in which 2 surgical tapes encircle the body and antrum of the stomach is indicated in patients who requiring pancreatic neck resection, dissection along the celiac trunk collaterals and lymph nodes, the duodenal wall, and the gastroduodenal artery. We describe our surgical technique, we compare our results between the double and single gastric hanging and we illustrate by 2 shorts videos for distal pancreatectomy and central pancreatectomy. Results: Between September 2016 and December 2017, this technique was performed in 36 patients who underwent central pancreatectomy (n = 18), distal pancreatectomy (n = 14), and enucleation (n = 4). There was no conversion, no transfusion, no mortalities, and no gastric related complications or reinterventions. Although not significant, the double gastric hanging and compared to single gastric hanging showed more favorable operative results with shorter operative time, less blood loss, and higher number of harvested lymph nodes. In patients operated for pancreatic adenocarcinoma, the mean number of harvested lymph nodes was higher with the double gastric hanging (23 vs. 14, p = 0.027). Conclusion: The double gastric hanging provides excellent exposure of the pancreatic neck, celiac trunk collaterals, and lymph nodes for better technical and oncological resections with no related complications.