Pancreaticogastrostomy: a further evaluation.

The anastomosis between the remaining pancreas and the intestinal tract after various types of pancreatic resection has been the site of complications responsible for considerable morbidity and mortality. After Whipple resections reestablishment of pancreatic-intestinal continuity has generally been accomplished in some manner between the pancreas and upper jejunum. This suture line has at times failed, often as the result of postoperative pancreatitis, giving rise to hemorrhage, abscess, and fistula formation. Since 1963, 25 patients undergoing pancreaticoduodenal resection have had some portion of their pancreas implanted into the back wall of the stomach. The operations have been done by the resident and senior staff of the Department of Surgery at the University of Pennsylvania. Morbidity has decreased and operative mortality has fallen from 20-30% to 8%. The technique is not difficult and there seems to be less tendency for the anastomosis to leak. Pancreatic function is usually adequate. The procedure is useful after radical resection of the pancreaticoduodenal region or at times after pancreatic trauma.