title: In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy.
abstract: BACKGROUND
  It has been suggested that pancreaticogastrostomy (PG) is a safer reconstruction than pancreaticojejunostomy (PJ), resulting in lower morbidity, including lower pancreatic leak rates and decreased postoperative mortality. We compared PJ and PG after pancreaticoduodenectomy (PD).
  
  
  METHODS
  A randomized clinical trial was designed. It was stopped with 50% accrual. Patients underwent either PG or PJ reconstruction. The primary outcome was the pancreatic fistula rate, and the secondary outcomes were overall morbidity and mortality. We used the Student t, Mann-Whitney U and χ(2) tests for intention to treat analysis. The effect of randomization, American Society of Anesthesiologists score, soft pancreatic texture and use of pancreatic stent on overall complications and fistula rates was calculated using logistic regression.
  
  
  RESULTS
  Our trial included 98 patients. The rate of pancreatic fistula formation was 18% in the PJ and 25% in the PG groups (p = 0.40). Postoperative complications occurred in 48% of patients in the PJ and 58% in the PG groups (p = 0.31). There were no significant predictors of overall complications in the multivariate analysis. Only soft pancreatic gland predicted the occurrence of pancreatic fistula (odds ratio 5.89, p = 0.003).
  
  
  CONCLUSIONS
  There was no difference in the rates of pancreatic leak/fistula, overall complications or mortality between patients undergoing PG and and those undergoing PJ after PD.
authors: The Division of General Surgery, University of Calgary, Calgary, Alta.
authors: Jan
authors: J
authors: Grendar
authors: CHU de Québec, Pavillon Hôspital de l'Enfant-Jesus, Quebec, Que.
authors: Jean-François
authors: JF
authors: Ouellet
authors: The Division of General Surgery, University of Calgary, Calgary, Alta.
authors: Francis R
authors: FR
authors: Sutherland
authors: The Division of General Surgery, University of Calgary, Calgary, Alta.
authors: Oliver F
authors: OF
authors: Bathe
authors: The Division of General Surgery, University of Calgary, Calgary, Alta.
authors: Chad G
authors: CG
authors: Ball
authors: The Division of General Surgery, University of Calgary, Calgary, Alta.
authors: Elijah
authors: E
authors: Dixon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult