Pancreaticogastrostomy following pancreatoduodenectomy.

Operative death following pancreatoduodenectomy results essentially from a pancreatojejunal anastomosis leakage. Pancreaticogastrostomy has been used infrequently. Seventeen patients (12 with malignant tumors and 5 with chronic pancreatitis) have undergone pancreaticogastrostomy following pancreatoduodenectomy. There was no operative mortality rate and no pancreaticogastrostomy leakage. Our data agree with data concerning pancreaticogastrostomy published in literature; cumulative mortality rate including our results is 4.5% (6 out of 134 patients) with only one transient benign pancreatic fistula reported. Many advantages offered by this method can explain these positive results including trypsine neutralization by gastric acidity and the possibility of nasogastric aspiration on contact with the anastomosis. Furthermore, permeability of the pancreatic duct can be easily verified by endoscopic examination. However, external pancreatic insufficiency does not seem to occur in long-term follow-up. These results suggest that this simple and safe method merits a more widespread application.