Pancreaticogastrostomy following pancreaticoduodenectomy: Review of 102 consecutive cases

Disruption of the pancreatic anastomosis with resultant sepsis is the cause of nearly 50% Of deaths following pancreaticoduodenectomy (PD), Traditiona lly, the pancreatic remnant is anastomosed to the jejunum, Pancreaticogastr ostomy (PG) was introduced as an alternative by Waugh and Clagett in 1946 a nd by Park Mackle, and Rhoads in 1967, The purpose of this retrospective re view was to assess the safety of PG at a single institution. Between 1986 a nd 1998 a total of 102 patients underwent PG following PD, The indications for PD were periampullary carcinoma (n = 89), pancreatitis (n = 7), and mis cellaneous (n = 6). Altogether, 80 patients underwent the traditional Whipp le procedure and 22 the pylorus-preserving Whipple (PPW) procedure. The PG was performed by a single-layer invagination technique to the posterior gas tric wall using interrupted silk sutures, Leaks from the pancreatic anastom osis were detected by measuring amylase in fluid obtained from surgically p laced drains. Operative mortality was 3.9% (4/102), The cause of death was uncontrolled upper gastrointestinal hemorrhage, sepsis, pulmonary embolus, and cardiac failure secondary to myocardial infarction, The mean operating time was 6.8 hours. Blood transfusion was given in 43 patients (42%), and t he mean amount of the transfusion was 2.6 units. Nonfatal complications occ urred in 35 patients (34%), and included leaks from the pancreatic anastomo sis in 9 (8.8%), leaks from the biliary-enterie anastomosis in 4 (3.9%), an d gastric paresis 7 (6.9%). Other complications included abscess, wound inf ection, colitis, delirium tremens, and hyperbilirubinemia, Discharge occurr ed 6 to 47 days (median 12 days) postoperatively and was prolonged in patie nts suffering from a complication. PD is associated with significant morbid ity, PG is a safe alternative to pancreaticojejunostomy for managing the pa ncreatic remnant.