Hypothesis
Pancreaticogastrostomy (PG) is associated with a lower relaparotomy rate following pancreaticoduodenectomy (PD) than pancreaticojejunostomy (PJ).
Design
Retrospective clinical trial.
Setting
Department of digestive surgery and transplantation.
Patients
Between 1987 and 2001, 250 consecutive patients underwent PD in our institution. Among them, 83 patients underwent PJ and 167, PG.
Main Outcome Measures
Preoperative clinicopathological features, intraoperative parameters, in-hospital mortality, postoperative morbidity, pancreatic fistula (PF), relaparotomy rates, and length of hospital stay were analyzed and compared between 2 reconstructive methods, PJ and PG, after PD.
Results
The morbidity rate, including PF, was lower in the PG group (38.3%) than in the PJ group (53.0%; P = .02). The mortality rate did not differ between the PG group (2.9%) and PJ group (2.4%). Conversely, the incidence of PF and the mean ± SD length of hospital stay were significantly lower in the PG group (2.3% and 17.2 ± 7.7 days) than in the PJ group (20.4% and 23.3 ± 11.7 days; P<.001 for both variables). Moreover, the overall relaparotomy rate was significantly lower in the PG group (4.7%) than in the PJ group (18.0%; P = .001). Nine (52.9%) of 17 patients with PF in the PJ group underwent relaparotomy. These 9 patients underwent subsequent completion pancreatectomy (n = 7) or removal of peripancreatic necrotized tissue (n = 2) with a postoperative mortality rate of 22.2%. However, no patient required relaparotomy for PF in the PG group because medical therapy succeeded in all 4 patients with PF. Moreover, no mortality related to PF occurred in the PG group.
Conclusion
The PG procedure is a safe method of reconstruction after PD, with a significantly lower rate of PF and relaparotomy.