Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy for carcinoma of the head of the pancreas, randomized study

ABSTRACT

Pancreaticoduodenectomy is the primary means of treating cancer head of the pancreas. Associated mortality rates have dropped dramatically in the past decade, but morbidity rates remain high. Patients were divided randomly into two groups- 1- The first group includes 49 patients have undergone pancreaticogastrostomy. 2- The second group includes 55 patients have undergone pancreaticojejunostomy. The patients were followed for the presence of complications especially pancreatic leak. The study included 104 patients divided randomizly into two groups the first group included 49 patients who had undergone pancreaticogastrostomy and the other group includes 55 patients who had undergone pancreaticojejunostomy. 70% were males, 30% were females, age 74 +/- 13 years. Comparing the complication observed after the two procedures, Multiple complications occurred in 30.6% in patients who undergone pancreaticogastrostomy and 38.18% in patients who undergone pancreaticojejunostomy. With no statistically significant difference between the 2 procedures. No reported mortality in the two groups had been observed. The most common complication observed in the pancreaticogastrostomy group was pancreatic fistula [14.28%] followed by intra-abdominal fluid [8.16%], biliary fistula, bleeding, reoperation [4.08%] each. For the pancreaticojejunostomy group the most common complication observed were pancreatic fistula [20%] followed by intra-abdominal fluid and reoperation [9.09%] each, biliary fistula [5.45%], no bleeding reported. pancreaticogastrostomy is associated with a lower frequency of multiple surgical complications which is not statistically significant and higher incidence of pancreatic fistula in the pancreaticojejunostomy arm