Pancreaticogastrostomy: preferred reconstruction for Whipple resection

Anastomotic leak is the main complication after Whipple procedures. We reviewed retrospectively our experience with pancreatic cancer patients treated with Whipple resection and reconstruction with a pancreaticogastrostomy (PG) or a pancreaticojejunostomy (PJ). Ten patients operated between 1966 and 1990 composed the PJ group. Eight patients operated recently made up the PG group. Data on age, length of stay (LOS), survival, and complications (early and late) were noted from patient's charts. Patients in the PJ group had an average age of 58.3 years, a mean LOS of 60.3 days (median, 48 days), and a mean survival of 14.5 months. PG group patients had a mean age of 64.5 years, an average LOS of 14.3 days (median, 14 days), and an average survival of 10+ months. None of these differences were significant. Major complications in the PJ group included 2 leaks, 2 cases of pancreatic insufficiency, and 2 deaths related to the anastomotic leaks. Eleven other major complications occurred. The PG group patients did not have any leaks. One developed pancreatic insufficiency. Complications in the PG group were much less serious than those in PJ group. The longest hospital stay in the PG group was 20 days (range, 2-20) and 144 days (range, 11-144) in the PJ group. We conclude that PG is superior to PJ because of the decreased incidence of anastomotic leaks and the less serious nature of the complications associated with PG.