Pancreatiocogastrostomy after Pancreatoduodenectomy

Abstract

Leakage from pancreaticojejunostomy is still the most worrying complication of pancreatoduodenectomy. The purpose of this study was to determine whether pancreatico-gastrostomy can be a safer alternative method of restoring pancreaticoenteric continuiry after pancreatoduodenctomy. A total of 16 patients have undergone pancreaticogastrostomy between January and May 1994. pancreatoduodeneoctomy was performed for common bile duct carcinoma (n=10), ampulla of Vater carcinoma (n=5) and gallbladder carcinoma (n=1). Conventional Whipple operation was performed in 5 cases and pylorus preserving operation was performed in 11 cases. One patients died of respiratory failure at postoperative 13th day without any abdominal complication. Four patients had major postoeprative complications, which were intraabdominal abscess, rupture of gastroduodenal atery aneurysm, biliary fistula and delayed gastric emptying. All of these were imporved with conservative measures. No pancreatic leaks or other complications related to the pancreaticogastrostomy occurred. Early postoperative follow-up by measurement of amylase in gastric aspirates, endoscopy and UGI has proven patency of pancreatic duct and intact anastomosis site and surrounding gastric mucosa. No evidence of exocrine or newly developed endocrine pancreatic insufficiency has been found during short-term follow-up period. In conclusion, pancreaticogastrostomy is a safe method of reconstruction after pancreatoduodenectomy and it may be safer than pancreaticojejunostomy. Further studies on the changes of remaining pancreas, patency of pancreatic duct and pan reatic insufficiency through long-term follow-up are needed.