Critical analysis of a large series of pancreaticogastrostomy after pancreaticoduodenectomy.

HYPOTHESIS Pancreaticogastrostomy is a safe operation for a variety of periampullary conditions. DESIGN Retrospective review of a prospectively collected database. SETTING An academic tertiary care university hospital and a Veterans Affairs hospital. PATIENTS A total of 235 consecutive patients who underwent pancreaticogastrostomy. MAIN OUTCOME MEASURES Indications for surgery, preoperative risk factors, intraoperative and postoperative variables, and factors that affect postoperative complications. RESULTS The most common initial symptoms were jaundice (73.2%), weight loss (23.8%), and abdominal pain (17.0%). The 4 most common indications for surgery were pancreatic adenocarcinoma (41.3%), ampullary carcinoma (17.0%), duodenal carcinoma (7.2%), and chronic pancreatitis (7.2%). The median operating time was 6.5 hours. Median blood loss was 900 mL. The median intraoperative blood transfusion was 0 U. The median postoperative length of stay was 9 days. Postoperative mortality was 0.9%. The most common complications were pancreatic fistulae (13.6%), 1 of which was thought to cause 1 of 2 mortalities in this series. Pancreatic fistulae developing after pancreaticogastrostomy were significantly related to a low preoperative alkaline phosphatase level and surgery for nonpancreatic pathologic findings. The presence of a fistula significantly increased the postoperative length of hospital stay. CONCLUSIONS Pancreaticogastrostomy is a safe operation associated with low mortality and morbidity rates and a pancreatic fistula rate of 13.6%. It should be considered as a suitable alternative for management of the pancreatic remnant after pancreaticoduodenectomy.