Feasibility, Morbidity and Mortality in Two Hundred Consecutive Cases of Pancreaticogastrostomy After Pancreaticoduodenectomy

Abstract

BackgroundPostoperative mortality associated with pancreaticoduodenectomy (PD) in high-volume hospitals is below 5%, yet morbidity rates range between 45% and 60%. Recent studies show a lower incidence of complications and postoperative pancreatic fistula (POPF) in pancreaticogastrostomy (PG). The primary objective was to assess the incidence and predictive factors for complications: POPF, post-pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) following the criteria of the ISGPS and Clavien-Dindo classifications. MethodsA prospective observational study that included all patients who underwent PD between 2008 and 2016. PG was the surgical procedure of choice for PD reconstruction. ResultsTwo hundred forty-nine (249) patients underwent surgery with intention of performing a PD. The feasibility of PG was 90.5%. One hundred and six (53%) patients had complications, 36 (18%) were severe (Clavien-Dindo grade ≥ III). Death within 90 postoperative days was 4%. DGE was the most frequent complication (22.5%), followed by PPH (21%). The clinical POPF rate was 15% (6% Clavien-Dindo grade ≥ III). The primary risk factors associated with complications were age >70 years (1.9 [1–3.55]), being male (1.89 (1; 3.6]) and soft pancreatic texture (3.38 [1.5; 7.37]). ConclusionsIn this paper, we report a feasibility study for PG (90.5%). The primary risk factors associated with complications are age >70 years, being male and soft pancreatic texture. Soft pancreatic texture is also associated with the development and severity of POPF.