Non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy

Abstract

Background: We hypothesized that neutralization of the gastric acidity by alkaline pancreatic secretion via a non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (non-stented PPPD-PG) might provide protection against marginal or stress ulcer. Surgical risk of non-stented pancreaticogastrostomy was also assessed to clarify the importance of stenting in pancreatic anastomosis.

Methods: From January 1997 to December 2000, 54 patients with resectable periampullary lesions were included for non-stented PPPD-PG. Gastric pH and amylase levels were measured on the postoperative day 7. Surgical risks including pancreatic leakage, morbidity and mortality were also assessed.

Results: Patients undergoing the non-stented PPPD-PG presented significantly higher gastric levels of pH and amylase than healthy patients as controls (median pH 5.0 vs 2.8, p = 0.007; and median amylase 7,660 vs 21 IU/L, p = 0.031). Among the patients undergoing the non-stented PPPD-PG, low gastric pH and amylase levels were associated with high gastric drainage group > or = 600 c.c./day. However, only 1 of the 18 patients with low gastric amylase level (high gastric drainage group) developed significant steatorrhea and needed replacement of concentrated pancreatic enzymes. There were 18 (33.3%) complications and 1 (1.8%) mortality. The cause of death was cardiac arrythmia, not related to operation. Gastric atonia was the most common complication (18.5%), followed by wound infection, intraabdominal abscess, and intraabdominal bleeding in 2 patients (5.6%) individually. No pancreatic leakage or ulcer-related complication occurred after non-stented PPPD-PG.

Conclusions: Experience of no pancreatic leakage in our 54 non-stented PPPD-PG implies that stenting of pancreaticogastrostomy might not be crucial in prevention of pancreatic leakage and ductal occlusion. Moreover, non-stented PPPD-PG can increase gastric pH and amylase levels, which might be beneficial in protection against marginal ulceration.