No mortality after 150 consecutive pancreatoduodenctomies with duct-to-mucosa pancreaticogastrostomy.
OBJECTIVE
The mortality rate after pancreatoduodenectomy (PD) remains 0-5% at major surgical centers with the major cause of operative death being a leak at the pancreaticojejunal anastomosis. The aim of this retrospective study was to evaluate the safety of duct-to-mucosa pancreaticogastrostomy (PG) at a single institute.


METHODS
One hundred fifty consecutive patients with pancreato-biliary diseases undergoing duct-to-mucosa PG following PD between 1995 and 2005 were evaluated. One hundred forty patients underwent a pylorus-preserving PD and 10 patients underwent a conventional PD (Whipple operation). External drainage of pancreatic juice was performed in 77 cases.


RESULTS
The mean operating time was 378 min and the mean blood loss was 1,640 ml. Blood transfusion was not required in 97 patients (65%). The morbidity rate was 50% (75/150), but the mortality rate was 0%. Pancreatic fistulae occurred in 11 patients (7%). Gender, age, operative procedure, portal vein resection, external drainage of the pancreatic juice, operative time, blood loss and blood transfusion did not affect the rate of pancreatic fistula. The rate of pancreatic fistulae tended to be lower in pancreatic carcinoma (3%) than non-pancreatic carcinoma (11%).


CONCLUSIONS
Duct-to-mucosa PG is a safe procedure for reconstruction following PD.
Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. mura777@hiroshima-u.ac.jp
Yoshiaki
Y
Murakami
Kenichiro
K
Uemura
Yasuo
Y
Hayashidani
Takeshi
T
Sudo
Yasushi
Y
Hashimoto
Naoya
N
Nakagawa
Hiroki
H
Ohge
Taijiro
T
Sueda
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome