Pancreaticojejunostomy or Pancreaticogastrostomy to Prevent Pancreatic Fistula Formation after Pancreaticoduodenectomy

Objective: To compare the results of pancreaticogastrostomy (PJ) with pancreaticojejunostomy (PG) in preventing fistula formation after pancreaticoduonectomy (PD). Study design: Quasi-experimental study. Place and Duration of Study: The study was carried out in Military and Combined Military Hospital Rawalpindi from August 2008 to March 2015 Material and methods: Patients of both gender aged 45-70 years with confirmed or suspected neoplasms of head of pancreas, periampullary or duodenal tumours were included. After pancreatico duodenectomy the pancreatic reconstruction was carried out either by pancreatico jejunostomy (duct to mucosa type, dunken in type) or double layer pancreatico gastrostmy.The fistula rate was recorded after both the procedures using the definition of International Study Group on Pancreatic Fistula. Results: During this study period, 30 patients underwent pancreaticoduodenectomy. In 21 (71.4%) patients pancreaticojejunostomy was done, (18 duct to mucosa type and three dunken type anastomosis) and in 9 (28.5%) patients pancreaticogastrostomy was carried out. Five (20%) patients (3 in duct to mucosa type and two in dunken type) in the pancreaticojejunostomy group developed pancreatic fistula (grade A=2, grade B=2 and grade C=1) and one patient (11.1%) in the pancreaticogastrostomy group developed postoperative pancreatic fistula (OR= 9.9, 95% CI: 1.06-92.7 p= 0.044) Conclusion: In patients undergoing PD for pancreatic head, periampullary or duodenal tumours, PG is more effective than PJ in reducing the frequency of post-operative pancreatic fistula