PANCREATICOGASTROSTOMY AFTER PANCREATICODUODENECTOMY - A RETROSPECTIVE STUDY OF 28 PATIENTS

Objective: To attempt to reduce the frequency and severity of postoper ative anastomotic leakage from pancreaticojejunostomy in patients unde rgoing pancreatoduodenectomy. Design: Retrospective case series. Setti ng: Tertiary referral center, department of general surgery, in the 31 -month period between April 1, 1993, and November 30, 1995. Patients a nd Intervention: Twenty-eight patients underwent pancreatoduodenectomy with pancreaticogastrostomy. Indications for surgery included carcino ma of the pancreas (n=14), carcinoma of the ampulla of Vater (n=8), di stal cholangiocarcinoma (n=3), duodenal carcinoma (n=1), an islet cell tumor (n=1), and cystadenoma of the pancreas (n=1). The median patien t age was 62 years (range, 34-76 years). The median duration of surger y was 6.75 hours (range, 4-12 hours). Main Outcome Measures: An anasto motic leak was defined as a recovery of more than SO mL/d of amylase-r ich fluid from the drains (>3 times the normal plasma levels) on or af ter the seventh postoperative day. Results: An anastomotic leak that l asted between 7 and 14 days developed in 4 patients (14.3%). A pancrea tic leak led to no major morbidity. In all cases, leakage was treated by temporary restriction of oral intake and nasogastric drainage. An i ntra-abdominal collection did not develop in any of these 4 patients. No patient required another surgical procedure for a pancreatic fistul a or abdominal collection. One patient (3.6%) died postoperatively. Th e median duration of the postoperative hospital stay was 20 days (rang e, 12-43 days), and all patients were discharged from the hospital aft er restoration of normal oral feeding. Conclusions: Pancreaticogastros tomy is a safe method for reconstruction of the pancreatic remnant aft er pancreatoduodenectomy for periampullary tumors. It results in an ac ceptable incidence of anastomotic leakage that is easily controlled by conservative measures.