Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy.
OBJECTIVE
Pancreatic leakage is a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Pancreaticogastrostomy (PG) has been reported to be associated with a lower pancreatic leakage rate and morbidity rate than pancreaticojejunostomy (PJ). This study compared the preoperative characteristics, surgical risk factors, intraoperative parameters, and postoperative outcome between PJ and PG.


METHODS
From March 1992 to March 2005, a comparative study between PJ and PG for patients with periampullary lesions undergoing PD was conducted. A total of 377 consecutive patients underwent PD. Among them, 188 patients underwent PJ and 189 underwent PG.


RESULTS
The overall mortality, morbidity and pancreatic leakage following PD were 5%, 45.1% and 10.6%, respectively. The mortality, morbidity and pancreatic leakage were 8.9%, 56.4% and 17.6% in the PJ group, and 2.1%, 33.9% and 3.7% in the PG group (p < 0.001). Mean operative time was 9.3 hours versus 6.7 hours (p < 0.001), mean blood loss was 1032 mL versus 891 mL (p = 0.064) and mean hospital stay was 34.8 days versus 26.1 days (p < 0.001) in the PJ and PG groups, respectively. PJ, soft pancreas, pancreatic duct stenting, low surgical volume (< 20) and age (> 65 years) were identified as risk factors for pancreatic leakage, while PJ, soft pancreas, pancreatic duct stenting and low surgical volume (< 20) were four significant risk factors for surgical morbidity. Further, PJ, pancreatic leakage, low surgical volume (< 20) and age (> 65 years) were identified to be surgical risk factors for mortality.


CONCLUSIONS
PG is a safer method than PJ following PD as a significantly lower rate of pancreatic leakage, surgical morbidity and mortality, shorter operation time, and shorter postoperative hospital stay are reported.
Fang
Wen-Liang
WL
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Shyr
Yi-Ming
YM
Su
Cheng-Hsi
CH
Chen
Tien-Hua
TH
Wu
Chew-Wun
CW
Lui
Wing-Yiu
WY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010182:Pancreatic Diseases / Q000209:etiology; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome