Purposes: The aim of this study was to assess the safety of the pancreatic anastomosis after pancreatico-duodenectomy (PD) & to compare the results of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) following pancreaticoduodenectomy in a prospective and randomized setting.
Background: Pancreatic fistula after pancreaticoduodenectomy represents a critical trigger of potentially life-threatening complications and is also associated with markedly prolonged hospitalization. The best method for dealing with the pancreatic stump after pancreaticoduodenectomy remains in question.
Patients and methods: The study included 50 patients; 33 (64%) males and 18 (36%) females with mean age of 66.3+4 years. All patients underwent clinical evaluation, laboratory assessment and CT or MRI examination. All patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy (group PJ). The postoperative follow up ranged from 6 months to 12 months.
Results: No mortality were recorded. Mean ICU stay duration was 2.4+0.8 days. The duration of hospital & ICU stay was shorter in group PG (P-value =0.03); The mortality due to surgical causes was higher in group PJ (P-value =0.02); The frequency of post operative complications i.e. pancreatic fistula (P-value =0.0343), intra-abdominal bleeding & collection (P-value =0.0376) were higher in group PJ; But there is no significance between both groups in the frequency of Abdominal wall abscess & biliary leakage (P-value =0.39). The cases of Intra-abdominal collection were treated well by conservative measures in group PG (P-value =0.023); But cases that needed open drainage were less (P-value =0.0376) & there was no significance between both groups in CT guided drainage (P-value =0.56).
Conclusions: Pancreaticogastrostomy could be considered better as a reconstruction method; with shorter hospital stay, No Necrosis of pancreatic remnant, Less frequency of post operative complications & So Re-do with its complication is also less.
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