[Pancreatojejunal or pancreatogastric anastomosis after cephalic duodenopancreatectomy. A comparative retrospective study].
OBJECTIVE
The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatico-duodenectomy.


METHODS
From January 1980 to June 1995, 171 patients underwent pancreatico-duodenectomy, 136 for pancreas, ampulla, distal bile duct or duodenum cancers, and 36 for chronic pancreatitis. Pancreatic anastomosis was realised by pancreatico-jejunostomy in 91 cases and by pancreatico-gastrostomy in 80 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups concerned mainly postoperative mortality and morbidity.


RESULTS
The overall postoperative mortality rate was significantly higher in the pancreatico-jejunostomy group (12%) than in the pancreatico-gastrostomy group (3.7%) (P = 0.05); death was directly related to necrosis of the remnant pancreas in four cases among the 14 postoperative deaths. The postoperative morbidity rate was respectively 23% after pancreatico-jejunostomy and 12.5% after pancreatico-gastrostomy; the pancreatic leakage and/or necrosis rate was higher in the pancreatico-jejunostomy group (13%) than in the pancreatico-gastrostomy group (3.75%) (P = 0.029).


CONCLUSIONS
This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but these results have to be confirmed or invalidated by a prospective multicentric randomised trial.
Tuech
J J
JJ
Département de chirurgie viscérale, CHU Angers, France.
Pessaux
P
P
Duplessis
R
R
Villapadierna
F
F
Ronceray
J
J
Arnaud
J P
JP
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D001649:Bile Duct Diseases / Q000209:etiology; D001650:Bile Duct Neoplasms / Q000601:surgery; D001658:Biliary Fistula / Q000209:etiology; D002423:Cause of Death; D002908:Chronic Disease; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods; D010195:Pancreatitis / Q000601:surgery; D012189:Retrospective Studies; D012449:Safety; D013270:Stomach / Q000601:surgery*; D015996:Survival Rate