[Pancreatoduodenectomy with pancreaticogastric anastomosis]

There is not general agreement concerning the ideal way of preventing pancreatic leakage after duodenopancreatectomy. The aim of the present study is to present the experience of a three years period of performing a pancreatogastroanastomosis (PGA) after duodenopancreatectomy (DPC) in 12 consecutive patients. In 7 cases PGA was performed after closure of the gastric stump using a transverse incision of the posterior wall of the stomach. A total layer of nylon 9 points was doubled by an interrupted serocapsular suture. In one case only the seromuscular layers of the stomach were cut, adjusted to the size of the pancreatic section with a central hole for the duct of Wirsung. Four nylon 10 points were used to anastomose the latter to the gastric mucosa. PGA was performed in one layer interrupted suture between the pancreatic capsule and the seromuscular of the stomach. In 4 cases, after closure of the gastric stump an anterior gastrotomy was associated to the posterior incision of the gastric wall in order to perform PGA using an intragastric route. The postoperative follow-up showed a good evolution with only one anastomotic leakage that necessitated reintervention in the 10th day. PGA might be elective after DPC when appropriate dissection and mobilisation of the pancreas is possible.