Pancreatogastrostomy (PG) after pancreatoduodenectomy with or without duct-to-mucosa anastomosis for the small pancreatic duct: short- and long-term results.

BACKGROUND/AIMS: Pancreatogastrostomy, generally considered to pose less postoperative complications for a small-duct pancreas after pancreatoduodenectomy than pancreatojejunostomy, has usually been conducted with an invagination method, which can cause obstruction of the duct during the follow-up. The purpose of this study was to investigate the short- and long-term results with special reference to the patency of the main pancreatic duct after pancreatogastrostomy performed on a small-duct pancreas, combining an invagination technique with a duct-to-mucosa approximation.
METHODOLOGY: Out of 73 patients with a nondilated pancreatic duct, 24 in an earlier series underwent pancreatogastrostomy only with an invagination. The other 49 in a later period had an additional duct-to-mucosa anastomosis.
RESULTS: Four patients (5.5%) developed a minor anastomotic leak of the pancreas which healed uneventfully within 16-41 days without mortality. Long-term results revealed that the pancreatic duct tended to dilate after pancreatogastrostomy without mucosal adaptation, while the new method of pancreatogastrostomy with duct-to-mucosa anastomosis left the diameter of the pancreatic duct unchanged. Body weight and peripheral blood glycohemoglobin A1c retained preoperative levels, irrespective of the mucosal anastomosis.
CONCLUSIONS: Pancreatogastrostomy with mucosa-to-mucosa anastomosis appears to be a useful method of pancreatic reconstruction in both the short- and long-term.