title: Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy.
abstract: OBJECTIVE
  To assess the safety of the pancreatic anastomosis after pancreatico-duodenectomy (PD).
  
  
  METHODS
  Non-randomized prospective trial in consecutive patients.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  171 consecutive patients with resectable periampullary cancer (80%) or intractable pain due to chronic pancreatitis (20%) undergoing PD.
  
  
  METHODS
  Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG).
  
  
  METHODS
  Mortality and morbidity rates due to anastomotic leak following PJ and PG.
  
  
  RESULTS
  91 PJ and 80 PG patients were comparable for age, gender, total bilirubin, ASA grading, indication for PD, operating time, pancreas texture, blood loss and replacement. The rate of pancreatic fistula was significantly higher in PJ patients (13%) than in PG patients (3.7%) (12 vs. 3, p = 0.029). Overall death rate was significantly higher after PJ (12%) than after PG (3.7%) (11 vs. 3, p = 0.047). Fatal outcome due to pancreatic leak (3 vs. 1, p = 0.83) and other death rates (8 vs. 2, p = 0.14) were not significantly different in PJ and PG groups, respectively.
  
  
  CONCLUSIONS
  PJ was associated with significantly higher pancreatic leak rate than PG. However, there was no statistically significant difference in mortality rates directly related to pancreatic leak.
authors.affiliation: Department of Visceral Surgery, University Hospital of Angers, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Arnaud
authors.forename: J J
authors.initials: JJ
authors.lastname: Tuech
authors.forename: C
authors.initials: C
authors.lastname: Cervi
authors.forename: R
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002908:Chronic Disease; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D010195:Pancreatitis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology