Pancreaticogastrostomy in patients with considerably dilated pancreatic ducts.

Background/aims: Patency of pancreaticogastrostomy (PG) is one of the most important factors affecting the function of the remnant pancreas and quality of life. We evaluated the early postoperative changes in pancreatic duct dilation after pancreaticoduodenectomy (PD) and PG with duct-to-mucosa anastomosis in patients with remarkably dilated pancreatic ducts.

Methodology: We retrospectively analyzed 26 patients who had remarkably dilated pancreatic ducts (diameter, ≥7 mm) and who underwent PD followed by PG. They were divided into 2 groups on the basis of the endoscopic findings of the anastomotic orifice of PG: Group A, clear pancreatic duct orifice with pancreatic juice output; and Group B, unclear pancreatic duct orifice with pancreatic juice output.

Results: The mean diameter of the duct of the remnant pancreas after the surgery was smaller in Group A than in Group B. With regards to postoperative pancreatic exocrine function, there was no significant difference between the 2 groups.

Conclusions: Invagination with duct-to-mucosa anastomosis is a useful technique to prevent pancreatic leakage; however, it is difficult to prevent inflammation and fibrosis around the anastomotic site of PG, and this can lead to anastomotic stricture in patients with a remarkably dilated pancreatic duct (diameter ≥7 mm).