The reconstruction after pylorus preserving pancreatoduodenectomy: pancreatogastrostomy with Roux-en-Y reconstruction versus conventional Traverso type reconstruction

Objective: To compare the result of pancreatogastrostomy (PG) with Roux-en-Y reconstruction versus pancreatojejunostomy (PJ) with conventional Traverso-type reconstruction following pylorus-preserving pancreatectomy (PPPD) in a retrospective study. PPPD has been accepted as a radical surgical treatment for malignant periampullary neoplasms. However, the reconstruction of this surgery is technically complicated. The leakage of pancreatic juice and the delayed gastric emptying are the major complications of PPPD and may be fatal. To solve these problems, we have performed PG with Roux-en-Y anastomosis. There are several techniques proposed the reconstruction after PPPD, however there have been no previous study describing the result of PG with Rouxen-Y anastomosis. Since 2002 we have performed 32 cases of PPPD. They were divided into two groups according to the reconstruction procedures: PG with Roux-en-Y reconstruction (group PG-RY) (17 cases) and pancreatojejunostomy with Traverso-type reconstruction (group PJ-T) (15 cases). Results: Patient age, gender, and underlying disease were comparable among the groups. Two groups showed no differences in intraoperative bleeding amount, and the time of surgery. The occurrence of the pancreatic leakage was significantly reduced in the group PG-RY compared with the group PJ-T. There was no case of the delayed gastric emptying in the group PGRY. Conclusions: Pancreatogastrosotmy with Roux-en-Y anastomosis can reduce the occurrence of the pancreatic leakage and delayed gastric emptying following pylorus-preserving pancreatoduodenectomy.