Current experience with pancreatogastrostomy

The reconstruction technique for the pancreatic remnant remaining after pancreatoduodenectomy has most frequently been pancreatojejunostomy. Although the mortality rate has been reduced to rather low levels in many centers, the leakage rate from this anastomosis remains high, in the range of 10% or greater. An alternative reconstruction, pancreatogastrostomy, has been known for almost 50 years and has been performed on small numbers of patients. The leakage rate for this anastomosis is less than 1% in literature reports in more than 200 patients. The purpose of this report was to add to the previously reported experience with this technique and to compare it with standard reconstruction as performed in a major American medical center by experienced surgeons.

The medical records of all patients operated on at the Loyola University Medical Center and the Edward Hines, Jr., Veteran's Affairs Hospital from August 1986 to May 1993, with a procedure code relating to the pancreas, were reviewed.

A total of 58 Whipple procedures were identified, including 34 pancreatogastrostomies, 23 pancreatojejunostomies and 1 stapled pancreatic stump. No leaks in any pancreatogastrostomies were observed in the 38 patients so treated, whereas 4 leaks and 2 deaths related to the anastomosis occurred in the group of 23 patients with pancreatojejunostomies. The average length of stay was 14.2 days for the pancreatojejunostomy group and 15.5 days for the pancreatogastrostomy group, excluding duration data from those who died or experienced leakage. There was no significant difference in the length of stay between pancreatojejunostomy and pancreactogastrostomy; there was a statistically significant lengthening of stay for those patients whose anastomosis leaked versus those whose did not leak. The 10 patients having a pylorus-sparing operation had an average postoperative stay of 16 days, including both types of reconstruction.

The gradual adoption of this procedure at a major medical center has led to the abandonment of pancreatojejunostomy as a reconstruction technique for the pancreatic remnant remaining after pancreatoduodenectomy.