Successful two-sided sponge pull-through treatment of anastomotic leakage following pancreaticoduodenectomy with pancreaticogastrostomy.

A 66-year-old man with pancreatic cancer developed an anastomotic leakage of the pancreaticogastrostomy 15 days after pylorus-preserving pancreaticoduodenectomy. An easy-flow drain was identified endoscopically in the extraluminal cavity. Two-sided sponge (TSS) treatment was initiated [1]. A gastric tube was attached to the outer end of the drain with adhesive tape (Opsite Flexfix; Smith & Nephew Medical, Hull, UK). The drain was then grasped inside the cavity with a forceps (foreign-body removing forceps; MTW Endoskopie Manufaktur, Wesel, Germany) (▶Fig. 1, ▶Video1). The drain was orally removed, with the gastric tube still attached to its end. The TSS (Braun, Melsungen, Germany) (▶Fig. 2) was connected to the gastric tube by adhesive tape, and was drawn into the cavity by pulling the abdominal end of the gastric tube. The oral end of the TSS tube was nasally diverted (▶Video1). Both ends of the TSS tube were connected to a vacuum pump (−30mmHg). When the TSS was changed at day 5, a clean cavity was seen (▶Fig. 3, ▶Video1). At day 9, sponge-induced granulation tissue was seen (▶Video1). A rubber drain was introduced (▶Fig. 4) to promote the formation of granulation tissue and thus definitive healing. At day