title: Non-stented pancreaticogastrostomy for 111 patients undergoing pylorus-preserving pancreaticoduodenectomy.
abstract: OBJECTIVE
  The main purpose is to clarify the roles of pancreatic stenting and duct-to-mucosa anastomosis in prevention of pancreatic leakage and exocrine insufficiency in pylorus-preserving pancreaticoduodenectomy with non-stented pancreaticogastrostomy (non-stented PPPD-PG).
  
  
  METHODS
  Prospectively-collected data from 111 patients with resectable periampullary lesions undergoing non-stented PPPD-PG between January 1997 and February 2003 were analyzed. Severity of postoperative steatorrhea was assessed. Surgical morbidity and mortality were evaluated.
  
  
  RESULTS
  Complications occurred in 38 (34.2%) patients, leading to 2 (1.8%) deaths. However, neither of the deaths were related to operation. The most common complication was gastric atonia (14.4%). Pancreatic leakage occurred only in 1 (0.9%) patient. Overall, there was no steatorrhea in 92 (82.8%) patients after non-stented PPPD-PG, including 69 (62.2%) patients without replacement of pancreatic enzymes and 23 (20.7%) patients after replacement of pancreatic enzymes. Moderate steatorrhea occurred in 17 (15.3%) patients, and severe steatorrhea only in 1 (0.9%) patient. Steatorrhea was significantly correlated with the consistency of pancreatic parenchyma (P=0.037), instead of the diameter of pancreatic duct.
  
  
  CONCLUSIONS
  The findings of low incidence of pancreatic leakage and steatorrhea in this non-stented PPPD-PG study imply that pancreatic stenting and duct-to-mucosa anastomosis may not be crucial in prevention of pancreatic leakage and exocrine insufficiency after reconstruction with pancreaticogastrostomy.
authors.affiliation: Department of Surgery, Veterans General Hospital-Taipei, National Yang Ming University, Taipei, Taiwan. ymshyr@vghtpe.gov.tw
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Shyr
authors.forename: Tien-Hua
authors.initials: TH
authors.lastname: Chen
authors.forename: Cheng-Hsi
authors.initials: CH
authors.lastname: Su
authors.forename: Chew-Wun
authors.initials: CW
authors.lastname: Wu
authors.forename: Wing-Yiu
authors.initials: WY
authors.lastname: Lui
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D004067:Digestive System Neoplasms / Q000601:surgery; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome