Non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND We hypothesized that neutralization of the gastric acidity by alkaline pancreatic secretion via a non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (non-stented PPPD-PG) might provide protection against marginal or stress ulcer. Surgical risk of non-stented pancreaticogastrostomy was also assessed to clarify the importance of stenting in pancreatic anastomosis. METHODS From January 1997 to December 2000, 54 patients with resectable periampullary lesions were included for non-stented PPPD-PG. Gastric pH and amylase levels were measured on the postoperative day 7. Surgical risks including pancreatic leakage, morbidity and mortality were also assessed. RESULTS Patients undergoing the non-stented PPPD-PG presented significantly higher gastric levels of pH and amylase than healthy patients as controls (median pH 5.0 vs 2.8, p = 0.007; and median amylase 7,660 vs 21 IU/L, p = 0.031). Among the patients undergoing the non-stented PPPD-PG, low gastric pH and amylase levels were associated with high gastric drainage group > or = 600 c.c./day. However, only 1 of the 18 patients with low gastric amylase level (high gastric drainage group) developed significant steatorrhea and needed replacement of concentrated pancreatic enzymes. There were 18 (33.3%) complications and 1 (1.8%) mortality. The cause of death was cardiac arrythmia, not related to operation. Gastric atonia was the most common complication (18.5%), followed by wound infection, intraabdominal abscess, and intraabdominal bleeding in 2 patients (5.6%) individually. No pancreatic leakage or ulcer-related complication occurred after non-stented PPPD-PG. CONCLUSIONS Experience of no pancreatic leakage in our 54 non-stented PPPD-PG implies that stenting of pancreaticogastrostomy might not be crucial in prevention of pancreatic leakage and ductal occlusion. Moreover, non-stented PPPD-PG can increase gastric pH and amylase levels, which might be beneficial in protection against marginal ulceration.