Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy.

Nineteen consecutive patients, 7 male and 12 female, underwent pancreaticoduodenectomy for malignancy during the 3-year period 1985-88. The pancreatic remnant in the first 12 patients (Group I) was managed alternately by pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Patients undergoing PJ and PG (6 each) were comparable in age, biochemical parameters and nature and extent of disease. Three patients, all in the PJ subgroup, died (25% mortality) due to pancreatic leak, biliary leak and hepatocellular failure. In view of the high complication rate following PJ, the remaining 7 patients (Group II) underwent PG. For patients undergoing PG, the hospital stay was shorter, complications were fewer and there was no anastomotic leak or death (0% mortality). This study represents the first attempt at comparison of PJ with PG in reconstruction following the Whipple procedure by the same team. The results suggest that PG deserves wider application.