Pancreaticogastrostomy after pancreaticoduodenectomy.

Abstract

Although the mortality following pancreaticoduodenectomy has fallen and is now below 5%, overall 14% of patients develop a leak at the pancreatic anastomosis. This complication carries a 24% mortality rate when pancreaticojejunostomy is the method of reconstruction. In order to reduce the incidence of this complication, pancreaticogastrostomy can be performed following pancreaticoduodenectomy. A total of 41 patients underwent this operation between 1968 and 1989. The indications for operations were carcinoma of the head of the pancreas (n = 19), carcinoma of the ampulla (n = 12), carcinoma of the lower end of the common bile duct (n = 6), chronic pancreatitis (n = 3) and one patient with a nonfunctioning islet cell tumour. One patient developed a pancreatic fistula which closed spontaneously in 5 days. This patient is alive and well 36 months after operation. Pancreaticogastrostomy with pancreatic duct to gastric mucosa anastomosis is recommended as a safe and straight-forward method of reconstruction following pancreaticoduodenectomy.