Pancreaticogastrostomy — An alternate for dealing with pancreatic remnant after pancreaticoduodenectomy — Experience from a tertiary care center of Pakistan

Whipple’s pancreaticoduodenectomy has been refined over the years to be a safe operation though the morbidity rate still remains high (30-50%). Pancreatic fistula is the most important cause of mortality following pancreaticoduodenectomy. To prevent it, surgeons have used two anastomotic techniques: pancreaticojejunostomy and pancreaticogastrostomy. Recent studies found that pancreaticogastrostomy is associated with fewer overall complications than pancreaticojejunostomy. This is a retrospective review of patients who underwent Whipple’s at Aga Khan University Hospital and had pancreaticogastrostomy as a preferred anastomosis for pancreatic stump. Forty four patients met the inclusion criteria, 27 were male. No patient developed post-operative pancreatic fistula, 13 (31%) patients had morbidities including delayed gastric emptying 4(9.1%), wound infection 3(6.8%), and haemorrhage 6(13.6%). Mortality is reported to be 5 (11.9%). Pancreaticogastrostomy seems to be a safe alternative and easier anastomosis to perform with less post-operative morbidity and mortality. Further data should become available with greater numbers in the future.