Pancreaticogastrostomy after pancreatoduodenectomy. A retrospective study of 28 patients.

Abstract

To attempt to reduce the frequency and severity of postoperative anastomotic leakage from pancreaticojejunostomy in patients undergoing pancreatoduodenectomy. Retrospective case series. Tertiary referral center, department of general surgery, in the 31-month period between April 1, 1993, and November 30, 1995. Twenty-eight patients underwent pancreatoduodenectomy with pancreaticogastrostomy. Indications for surgery included carcinoma of the pancreas (n = 14), carcinoma of the ampulla of Vater (n = 8), distal cholangiocarcinoma (n = 3), duodenal carcinoma (n = 1), an islet cell tumor (n = 1), and cystadenoma of the pancreas (n = 1). The median patient age was 62 years (range, 34-76 years). The median duration of surgery was 6.75 hours (range, 4-12 hours). An anastomotic leak was defined as a recovery of more than 50 mL/d of amylase-rich fluid from the drains (> 3 times the normal plasma levels) on or after the seventh postoperative day. An anastomotic leak that lasted between 7 and 14 days developed in 4 patients (14.3%). A pancreatic leak led to no major morbidity. In all cases, leakage was treated by temporary restriction of oral intake and nasogastric drainage. An intra-abdominal collection did not develop in any of these 4 patients. No patient required another surgical procedure for a pancreatic fistula or abdominal collection. One patient (3.6%) died postoperatively. The median duration of the postoperative hospital stay was 20 days (range, 12-43 days), and all patients were discharged from the hospital after restoration of normal oral feeding. Pancreaticogastrostomy is a safe method for reconstruction of the pancreatic remnant after pancreatoduodenectomy for periampullary tumors. It results in an acceptable incidence of anastomotic leakage that is easily controlled by conservative measures.