The anastomosis between the remaining pancreas and the intestinal tract after pancreatoduodenectomy(PD) has been the site of complications responsible for considerable morbidity and mortality. Pancreatogastrostomy(PG) has been recommended by a
few
surgeons based on some theoretical and practical advantages over pancreatojejunostomy(PJ), The purpose of this study was to determine whether PG can be a safe alternative to PJ. Eighty-six PDs performed by a single surgeon for periampullary
carcinomas
during 4.5-year period from Mar. 1991 to Sep. 1995. were analyzed to compare the early results of PJ (n=38) and PG(n=48). PG was performed at the low body posterior wall of the stomach by two-layer interruped suture. The two groups were
comparable
for
age, sex, diagnosis, stage, and operation time. In the PJ group, anastomotic leakage developed n 6 patients(15.8%) and 3 of them(7.9%) died of complications related to leakage. In the PG group, 1 patient (2.1%) developed leakage and expired due
to
bleeding and 1 patient died of respiratory failure without any abdominal complications. The pancreatic leakage rate was lower in the PG group than in PJ(P<0.05). Other major complications and incidence in PJ/PG group were biliary fistula(3/1),
bleeding(0/1), abdominal abscess(2/2), delayed gastric emptying(0/2), choledochojejunostomy stricture(0/1), afferent-loop obstruction(1/0) and hepatic dysfuction(1/0) respectively. Overall morbidity/hospital mortality were 34.2/7.9% and 18.8/4.2%
in PJ
and PG group, respectively. No evidence of endo/exocrine insufficiency insufficiency has been found during the follow-up except two who developed diabetes, one in the PJ and the other in the PG group A suspicious marginal ulcer was detected in
one
patient in the PJ group. In conclusion, PG showed a more favorable early outcome than PJ. Besides, considering technical feasability and easy postoperative access, PG is the recommended procedure for reconstruction after PD.
|