Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma.
BACKGROUND
Management of the pancreatic stump after pancreaticoduodenectomy (PD) is still a matter of debate. Pancreaticojejunostomy (PJ) is used commonly but is associated with a significant incidence of pancreatic leaks. Pancreaticogastrostomy (PG) is an alternative that has been reported to be safer.


METHODS
The study is a retrospective analysis of all patients having PD for ampullary carcinoma in one surgical unit at All India Institute of Medical Sciences over 18 years, with PG being the only drainage procedure for the pancreatic stump.


RESULTS
Among 125 patients having PD for ampullary carcinoma, overall morbidity rate was 28%, mortality rate was 4.8%, with no cases of leakage from the pancreaticogastrostomy.


CONCLUSIONS
In world literature (including the current series), the leakage rate of PG is 2.5% (14 of 553) with only 2 deaths (2 of 14) due to leakage from PG. Our large experience and these data conclusively prove the safety of pancreaticogastrostomy, which should be the drainage procedure of choice for the pancreatic stump following pancreaticoduodenectomy.
Kapur
B M
BM
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi.
Misra
M C
MC
Seenu
V
V
Goel
A K
AK
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies