Pancreatico-jejunostomy versus pancreatico-gasrostomy after pancreatico-duodenectomy in decreasing postoperative pancreatic fistula

Abstract

Background Pancreatico-duodenectomy is still the cornerstone in curating pancreatic and periampullary cancers. Many techniques for pancreatic anastomosis were described. Pancreatico-gastrostomy (PG) may be a suitable technique, especially in small pancreatic ducts where the stitching of duct to mucosa may be difficult. Still, the results of pancreatico-gastrostomy compared to pancreatico-jejunostomy (PJ) in terms of morbidity are not well studied; hence, this study was designed to investigate. Objective To compare pancreatico-gastrostomy versus pancreatico-jejunostomy post pancreatico-duodenectomy from points of operative techniques and characteristics, and postoperative morbidity and mortality. Patients and methods The Cohort study included all cases diagnosed with either pancreatic head or periampullary cancers and underwent pancreatico-duodenectomy at National Cancer Institute (NCI), Cairo University, between January 2021 and February 2023. Cases were enrolled into one of the two groups, group 1: underwent pancreatico-gastrostomy, while group 2 underwent pancreatico-jejunostomy. The two groups were compared by: Demographic characteristics, preoperative investigations results, operative, postoperative data and histopathological results of the specimens resected. Results Incidence of the pancreatic leak was not significantly different in both groups (17.6% versus 15.8% for PG and PJ respectively, P=0.833), operative time was shorter in a pancreatico-gastrostomy group (310, 355 min, P=0.001), Delayed gastric emptying (DGE) was less occurred in cases of pancreatico-gastrostomy (5.9%, 31.6%, P=0.006). Postoperative mortality was not different in both groups (8.8%, 2.6% for PG and PJ respectively, P=0.338). Conclusion Regarding the incidence of postoperative pancreatic fistula, both reconstruction methods produce comparable postoperative results. Pancreatico-gastrostomy is a good alternative technique to the standard pancreatico-jejunostomy.