Pancraeticojejunostomy vs. Pancreaticogastrostomy in Whipple's Operation: A Literature Review

Abstract

Pancreatic malignancy is one of the leading causes of morbidity and mortality. The definitive surgical treatment for resectable pancreatic cancer includes pancreaticoduodenectomy (Whipple Operation). Operative morbidity and mortality following pancreaticoduodenectomy (PD) is mainly associated with leakage of pancreatic enzymes leading to formation of either pancreatic fistulas or intra abdominal collections. Various types of pancreatico-enteric anastomosis have been proposed to prevent these complications. Different studies have been performed to compare the outcomes of Pancreaticogastrostomy (PG) verses Pancreaticojejunostomy (PJ) in terms of incidence of post operative pancreatic fistulas (POPF). Although it is widely accepted that no one technique is superior to the other but one of the underlying facts is that there are various ways of doing pancreatic anastomosis and moreover individual surgeons comfort and practice also matters. A review of literature was carried out to address the techniques of doing PJ and PG and comparison of postoperative complication rate in Pancreaticogastrostomy (PG) verses Pancreaticojejunostomy (PJ). We concluded that techniques of doing PJ and PG are surgeon dependent according to the characteristics of pancreatic remnant stump and there is no significant difference in the rate of clinical POPF between PG and PJ.