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Pancreaticogastrostomy: unreliable long-term pancreatic duct patency
Isao Kurosaki1, Katsuyoshi Hatakeyama, Takashi Kobayashi
1Department of Surgery, School of Medicine, Faculty of Medicine, Niigata University, 1-757 Asahimachi-dori, Niigata City, 951 Japan.
Background/Aims:
Long-term patency of pancreaticogastrostomy remains unclear. The purpose of this study is to clarify the long-term patency of pancreaticogastrostomy based on change in the main pancreatic duct diameter.
Methodology:
Seventeen of 33 patients who underwent pancreaticogastrostomy in our institution were divided into 2 groups according to the preoperative diameter of main pancreatic duct: the non-dilated group (phi main pancreatic duct < or = 4 mm, 11 patients) and the dilated group (phi main pancreatic duct > or = 5 mm, 6 patients). Clinical and radiological parameters were assessed by a postoperative comparison between the 2 groups.
Results:
phi main pancreatic duct after operation was dilated in all 11 patients in the non-dilated group, and the difference was significant (p = 0.0003, mean dilatation ratio = 2.6) when compared with phi main pancreatic duct before operation. In contrast, the mean phi main pancreatic duct decreased after operation (mean dilatation ratio = 0.9) in the dilated group. Clinical symptoms (5 patients), impaired endocrine and exocrine pancreatic function (4 and 3 patients, respectively), elevated serum amylase level (6 patients), and pancreatic parenchymal changes on radiological examinations (5 patients) were observed only in the non-dilated group.
Conclusions:
Degree of dilatation of main pancreatic duct seems to correspond to likelihood of anastomotic stenosis of pancreaticogastrostomy. Pancreaticogastrostomy has less reliability in terms of the long-term patency in cases having non-dilated main pancreatic duct.