Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma

• Published in: The American journal of surgery 1998-09, Vol.176 (3), p.274-278
• Main Authors: Kapur, Brij M.L, Misra, Mahesh C, Seenu, Vuthaluru, Goel, Arun Kumar
• Format: Article
• Language: English
• Subjects: Abdomen; Abscesses; Adult; Aged; Ampulla of Vater - surgery; Anastomosis, Surgical - methods; Bile ducts; Biological and medical sciences; Cancer; Carcinoma; Carcinoma - mortality; Carcinoma - surgery; Cardiovascular disease; Cause of Death; Common Bile Duct Neoplasms - mortality; Common Bile Duct Neoplasms - surgery; Drainage - methods; Female; Fistula; Gastrostomy - methods; Heart attacks; Hemorrhage; Humans; Leakage; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical science; Medical sciences; Middle Aged; Morbidity; Mortality; Pancreas; Pancreas - surgery; Pancreaticoduodenectomy; Pancreatitis; Parenteral nutrition; Patients; Postoperative Complications - epidemiology; Retrospective Studies; Sepsis; Small intestine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical anastomosis; Surgical drains; Wound drainage
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00139-1

Background: Management of the pancreatic stump after pancreaticoduodenectomy (PD) is still a matter of debate. Pancreaticojejunostomy (PJ) is used commonly but is associated with a significant incidence of pancreatic leaks. Pancreaticogastrostomy (PG) is an alternative that has been reported to be safer. Methods: The study is a retrospective analysis of all patients having PD for ampullary carcinoma in one surgical unit at All India Institute of Medical Sciences over 18 years, with PG being the only drainage procedure for the pancreatic stump. Results: Among 125 patients having PD for ampullary carcinoma, overall morbidity rate was 28%, mortality rate was 4.8%, with no cases of leakage from the pancreaticogastrostomy. Conclusions: In world literature (including the current series), the leakage rate of PG is 2.5% (14 of 553) with only 2 deaths (2 of 14) due to leakage from PG. Our large experience and these data conclusively prove the safety of pancreaticogastrostomy, which should be the drainage procedure of choice for the pancreatic stump following pancreaticoduodenectomy.