Pancreaticogastrostomy after pancreatoduodenectomy: A retrospective study of 28 patients

Objective: To attempt to reduce the frequency and severity of postoperative anastomotic leakage from pancreaticojejunostomy in patients undergoing pancreatoduodenectomy. Design: Retrospective case series. Setting: Tertiary referral center, department of general surgery, in the 31-month period between April 1, 1993, and November 30, 1995. Patients and Intervention: Twenty-eight patients underwent pancreatoduodenectomy with pancreaticogastrostomy. Indications for surgery included carcinoma of the pancreas (n=14), carcinoma of the ampulla of Vater (n=8), distal cholangiocarcinoma (n=3), duodenal carcinoma (n=1), an islet cell tumor (n=1), and cystadenoma of the pancreas (n=1). The median patient age was 62 years (range, 34-76 years). The median duration of surgery was 6.75 hours (range, 4-12 hours). Main Outcome Measures: An anastomotic leak was defined as a recovery of more than 50 mL/d of amylase rich fluid from the drains (>3 times the not levels) on or after the seventh postoperative Results: An anastomotic leak that lasted between 14 days developed in 4 patients (14.3%). A pancreatic leak led to no major morbidity. In all cases, leakage treated by temporary restriction of oral intake and nasogastric drainage. An intra- abdominal collection did not develop in any of these 4 patients. No patient required another surgical procedure for a pancreatic fistula or abdominal collection. One patient (3.6%) died postoperatively. The median duration of the postoperative hospital stay was 20 days (range, 12-43 days), and all patients were discharged from the hospital after restoration of normal oral feeding. Conclusions: Pancreaticogastrostomy is a safe method for reconstruction of the pancreatic remnant after pancreatoduodenectomy for periampullary tumors. It results in an acceptable incidence of anastomotic leakage that is easily controlled by conservative measures.