Pancreaticogastrostomy After Whipple’s Surgery Avoids Pancreatic Fistula—a Large Case Series Analysis

Abstract

Various modifications of the reconstruction following pancreaticoduodenectomy (PD) have been described. Pancreaticogastrostomy (PG) was first described clinically by Waugh and Clagett from the Mayo Clinic in 1946. Despite recent randomized trials and meta-analysis, the literature is still ambiguous as to which is a safer procedure. We hereby describe our experience of more than 400 pancreaticogastrostomies. The legacy of performing only pancreaticogastrostomy (PG) started by the senior author (BMLK) continued from 1977 to date in this surgical unit of a tertiary care hospital. We present the results of this case series analysis of a total of 467 Whipple’s pancreaticoduodenectomy in whom PG was performed. The mean operative time was 260.8 ± 50.3 min (180–390 min) with an average blood loss of 1068 ± 606.19 ml (400–2600 ml). None of the patients had clinically significant POPF. Thirty-five patients had postoperative bleeding out of which 12 were early and 23 had delayed hemorrhage. The most common postoperative complication was delayed gastric emptying which was seen in 96 patients (20.5%). Transient bile leak was seen in 84 patients (18%). Wound infection was seen in 70 (15%) patients. The overall 30-day mortality was 2% (10 out of 400). PG as a reconstructive technique is a safe option following PD with minimal incidence of clinically significant postoperative pancreatic fistula (POPF) as shown in our series of more than 400 patients. This is the largest series to date of pancreaticogastrostomy following PD.