Pancreaticojejunal Anastomosis Is Preferable to Pancreaticogastrostomy after Pancreaticoduodenectomy for Longterm Outcomes of Pancreatic Exocrine Function

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Abstract
The aim of this study was to evaluate pancreatic exocrine and endocrine function after pancreaticoduodenectomy. Pancreatic exocrine function was evaluated by a questionnaire and medical examination of stools after discontinuing pancreatic enzyme supplements for at least 10 days. Severe steatorrhea was defined as frequent, nauseating, yellow, and pasty stools, fecal output >200 g/d for more than 3 days. Endocrine function was evaluated by blood glucose level. Association between severe steatorrhea and age, indication, histologic obstructive pancreatitis, pancreaticojejunal anastomosis (PJA), pancreaticogastric anastomosis (PGA), and morbidity was studied. Fifty-two patients underwent pancreaticoduodenectomy, complication rate was 33%. PJA was performed in 41 patients (79%) and PGA in 11 patients (21%). At a median followup of 75 months (24 to 156 months), 65% of the patients received pancreatic enzyme supplements. Severe steatorrhea was observed in 22 patients (42%). Incidence of postoperative diabetes was 14.6%. Patient age (more than 60 years), postoperative complication, and obstructive pancreatitis were not associated with postoperative severe steatorrhea. In cases of nonhistologic obstructive pancreatitis, PGA was more frequently associated with severe steatorrhea than PJA (70% versus 21.7%, p < 0.025). No factor significantly influenced incidence of postoperative diabetes. After pancreaticoduodenectomy, 42% of patients presented with severe steatorrhea. PJA allows better pancreatic exocrine function preservation than PGA and should be recommended.