Critical analysis of a large series of pancreaticogastrostomy after pancreaticoduodenectomy

Hypothesis: Pancreaticogastrostomy is a safe operation for a variety of periampullary conditions. Design: Retrospective review of a prospectively collected database. Setting: An academic tertiary care university hospital and a Veterans Affairs hospital. Patients: A total of 235 consecutive patients who underwent pancreaticogastrostomy. Main Outcome Measures: Indications for surgery, preoperative risk factors, intraoperative and postoperative variables, and factors that affect postoperative complications. Results: The most common initial symptoms were jaundice (73.2%), weight loss (23.8%), and abdominal pain (17.0%). The 4 most common indications for surgery were pancreatic adenocarcinoma (41.3%), ampullary carcinoma (17.0%), duodenal carcinoma (7.2%), and chronic pancreatitis (7.2%). The median operating time was 6.5 hours. Median blood loss was 900 mL. The median intraoperative blood transfusion was 9 mL. The median postoperative length of stay was 9 days. Postoperative mortality was 0.9%. The most common complications were pancreatic fistulae (13.6%), 1 of which was thought to cause 1 of 2 mortalities in this series. Pancreatic fistulae developing after pancreaticogastrostomy were significantly related to a low preoperative alkaline phosphatase level and surgery for nonpancreatic pathologic findings. The presence of a fistula significantly increased the postoperative length of hospital stay. Conclusions: Pancreaticogastrostomy is a safe operation associated with low mortality and morbidity rates and a pancreatic fistula rate of 13.6%. It should be considered as a suitable alternative for management of the pancreatic remnant after pancreaticoduodenectomy.