Reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy.
BACKGROUND
Metaanalysis of retrospective studies employing various definitions of pancreatic fistulas demonstrated a reduced postoperative pancreatic fistula rate after pancreatogastrostomy versus pancreaticojejunostomy. Prospective trials failed to do so, which causes an ongoing debate on the superiority of one or the other procedure. The aim of this study was to compare the two types of anastomosis at our institution with regard to postoperative pancreatic fistula and other complications.


METHODS
From 2001 to 2007, 114 pancreatogastrostomies and 115 pancreaticojejunostomies were performed. For retrospective analysis, the ISGPS definitions were employed. Primary endpoint was the occurrence of postoperative pancreatic fistula grade B or C. Secondary endpoints were postpancreatectomy hemorrhage, delayed gastric emptying, intraabdominal fluid collection, reoperation, and mortality. Operative time, intensive care unit stay, and overall hospital stay were also compared.


RESULTS
With pancreatogastrostomy, there were significantly less postoperative pancreatic fistulae grade B and C (pancreatogastrostomy (PG) versus pancreaticojejunostomy (PJ), 11.4% versus 22.6%, p = 0.03), more intraluminal hemorrhage (PG versus PJ, 10.5% versus 0%, p < 0.001) and more delayed gastric emptying grade B and C (PG versus PJ, 18.3% versus 7.9%, p = 0.03). Operative time was shorter (PG versus PJ, median 420 versus 450 min, p < 0.01), and intensive care unit stay was longer (PG versus PJ, median 4 days versus 5 days, p < 0.01), with a tendency toward reduced overall hospital stay (PG versus PJ, median 17 versus 19 days, p = 0.08).


CONCLUSIONS
Surgeons should be aware of a higher rate of delayed gastric emptying and perform meticulous hemostasis to prevent intraluminal bleeding with pancreatogastrostomy. Pancreatogastrostomy is superior to pancreaticojejunostomy in terms of relevant postoperative pancreatic fistula.
Wellner
U
U
Department of Surgery, Chirurgische Universitätsklinik Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Makowiec
F
F
Fischer
E
E
Hopt
U T
UT
Keck
T
T
D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D005260:Female; D005746:Gastric Emptying; D005774:Gastrostomy / Q000009:adverse effects*; D006488:Hemostasis, Surgical; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000453:epidemiology; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D013536:Suture Techniques