Comparison of postoperative morphological changes in remnant pancreas between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy.
OBJECTIVE
The aim of this study was to compare postoperative morphological changes in remnant pancreas between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD).


METHODS
The study subjects were 28 patients with PJ and 14 with PG. The diameter of the main pancreatic duct (MPD) and pancreatic parenchymal thickness 2 years after PD were measured on computed tomography scans and compared between the 2 groups.


RESULTS
The preoperative and postoperative MPD diameter was 5.2 mm (SD, 2.4 mm) and 4.2 mm (SD, 2.0 mm) in the PJ group (P = 0.0422) and 4.8 mm (SD, 3.2 mm) and 5.7 mm (SD, 1.8 mm) (P = 0.1494) in the PG group, respectively. In those patients with preoperatively normal-size MPD, MPD after surgery tended to become dilated relative to before surgery in the PJ group (P = 0.0931), and the MPD measured postoperatively was significantly larger than preoperatively in the PG group (P = 0.0009). A significant atrophy of the pancreatic parenchyma was noted postoperatively in both groups (P < 0.0001), but these changes were more severe in the PG group than the PJ group (P = 0.0018).


CONCLUSIONS
Considering the above postoperative morphological changes, PJ seems to be preferable to PG after pancreaticoduodenectomy.
Tomimaru
Yoshito
Y
Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Takeda
Yutaka
Y
Kobayashi
Shogo
S
Marubashi
Shigeru
S
Lee
Chun Man
CM
Tanemura
Masahiro
M
Nagano
Hiroaki
H
Kitagawa
Toru
T
Dono
Keizo
K
Umeshita
Koji
K
Wakasa
Kenichi
K
Monden
Morito
M
D000368:Aged; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy