Results of pancreaticogastrostomy after pancreaticoduodenectomy in 159 consecutive cases.

Background: Pancreaticogastrostomy has been known as a method of reconstruction after pancreaticoduodenectomy for almost 60 years. According to some published reports, the pancreatic fistula rate for pancreaticogastrostomy is low. The purpose of this study is to present the results of pancreaticogastrostomy after pancreaticoduodenectomy at one department of our university hospital.

Methods: From 1994 to 2004, 159 patients underwent pancreaticoduodenectomy. Whipple procedures were performed in 125 cases and 34 underwent pylorus-preserving modification. In all of them, pancreaticogastrostomy was the method of choice for pancreatic-enteric anastomosis. The main outcome measures were postoperative morbidity and mortality.

Results: There were 56 patients (35%) who developed postoperative complications. 20 of them were reoperated due to pancreatic fistula (4), pancreatic fistula and biliary stenosis (1), biliary leak (2), enteric anastomosis leak (1), hemorrhage from the pancreaticogastric anastomosis (6), intra-abdominal bleeding (2), abdominal abscess (2) and evisceration (2). The other 36 patients were managed conservatively. The appearance of pancreatic fistulas had a statistically significant influence on the duration of hospitalization only. Six patients (3.7%) died. Two of them had pancreatic fistula.

Conclusion: We recommend pancreaticogastrostomy as a simple and safe method of reconstruction after pancreatico- duodenectomy with low mortality and morbidity rates. and IAP.