Pancreaticogastrostomy: How I Do It

  • R. Mahendran
  • H. S. Shukla


Pancreaticogastrostomy (PG) was first described by Waugh and Clagett from Mayo Clinic in 1946 [1]. Flaunter et al. popularized the technique and published their series in 1985 [2, 3]. Numerous theoretical and technical advantages are attributed to PG to explain the apparent safety of this procedure [4] including (1) the inactivation of pancreatic enzymes due to the low pH of the gastric lumen and lack of enterokinase in the gastric mucosa; (2) the alkaline pancreatic secretions that may help protect the pancreaticogastric anastomosis against marginal ulceration; (3) the anatomical proximity of the posterior gastric wall to the pancreatic remnant that allows for a very secure anastomosis without tension; (4) the thick gastric wall with its excellent blood supply that holds sutures very well; and (5) postoperative gastric decompression that is easily performed and provides constant removal of pancreatic and gastric secretions, thereby allowing less tension on the pancreaticogastric anastomosis.


  1. 1.
    Waugh JM, Clagett OT. Resection of the duodenum and head of the pancreas for carcinoma. Surgery. 1946;20:224–32.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Flautner L, Tihanyi T, Szecseny A. Results in 101 cases of pancreaticoduodenectomy in the management of chronic pancreatitis. Method of pylorus preservation versus Whipple’s operation. Orv Hetil. 1985;126(48):2943–9.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Flautner L, Tihanyi T, Szecseny A. Pancreaticogastrostomy: an ideal complement to pancreatic head resection with preservation of pylorus in the treatment of chronic pancreatitis. Am J Surg. 1985;150(5):608–11.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Delcore R, Thomas JH, Pierce GE, et al. Pancreaticogastrostomy: a safe drainage procedure after pancreatoduodenectomy. Surgery. 1990;108:641–7.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Mackie JA, Rhoads JE, Park CD. Pancreaticogastrostomy: a further evaluation. Ann Surg. 1975;181:541–5.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Peng SY, Wang JW, Hong DF, Liu YB, Wang YF. Binding pancreaticoenteric anastomosis: from binding pancreaticojejunostomy to binding pancreaticogastrostomy. Updates Surg. 2011;63(2):69–74. Epub 2011 Mar 26CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Telford GL, Mason GR. Pancreaticogastrostomy: clinical experience with a direct pancreatic-duct-to-gastric-mucosa anastomosis. Am J Surg. 1984;147:832–7.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Miyagawa S, Makuuchi M, Lygidakis NJ, Noguchi T, Nishimaki K, Hashikura Y, et al. A retrospective comparative study of reconstructive methods following pancreaticoduodenectomy - pancreaticojejunostomy vs pancreaticogastrostomy. Hepatogastroenterology. 1992;39:381–4.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Baumel H, Huguier M, Manderscheid JC, Fabre JM, Howry S, Fagot H. Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery. Br J Surg. 1994;81:102–7.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Mason GR, Freeark RJ. Current experience with pancreaticogastrostomy. Am J Surg. 1995;169:217–9.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Tuech JJ, Pessaux P, Duplessis R, Villapadierna F, Ronceray J, Arnaud JP. Pancreaticojejunal or pancreatogastric anastomosis after cephalic duodenopancreatectomy. A comparative retrospective study. Chirurgie. 1998;123:450–5.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Arnaud JP, Tuech JJ, Cervi C, Bergamaschi R. Pancreaticogastrostomy compared with pancreaticojejunostomy after pancreaticoduodenectomy. Eur J Surg. 1999;165:357–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Takano S, Ito Y, Oishi H, Kono S, Yokoyama T, Kubota N, et al. A retrospective analysis of 88 patients with Pancreaticogastrostomy after pancreaticoduodenectomy. Hepatogastroenterology. 2000;47:1454–7.PubMedGoogle Scholar
  14. 14.
    Arkossy P, Toth P, Kovacs I, Sapy P. New reconstructive surgery of remnant pancreas in cases of cancer of Vater’s papilla. Hepatogastroenterology. 2002;49:255–7.PubMedGoogle Scholar
  15. 15.
    Schlitt HJ, Schmidt U, Simunec D, Jager M, Aselmann H, Neipp M, et al. Morbidity and mortality associated with pancreatogastrostomy and pancreatojejunostomy following partial pancreatoduodenectomy. Br J Surg. 2002;89:1245–51.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Aranha GV, Hodul P, Golts E, Oh D, Pickleman J, Creech S. A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy. J Gastrointest Surg. 2003;7:672–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Oussoultzoglou E, Bachellier P, Bigourdan JM, Weber JC, Nakano H, Jaeck D. Pancreaticogastrostomy decreased relaparotomy caused by PF after pancreaticoduodenectomy compared with pancreaticojejunostomy. Arch Surg. 2004;139:327–35.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Guerrini GP, Soliani P, D'Amico G, Di Benedetto F, Negri M, Piccoli M, Ruffo G, Orti-Rodriguez RJ, Pissanou T, Fusai G. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: an up-to-date meta-analysis. J Invest Surg. 2016;29(3):175–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Que W, Fang H, Yan B, Li J, Guo W, Zhai W, Zhang S. Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Am J Surg. 2015;209(6):1074–82.CrossRefPubMedGoogle Scholar
  20. 20.
    Zhang X, Ma L, Gao X, Bao H, Liu P, Aziz A, Wang Z, Gong P. Pancreaticogastrostomy versus pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Surg Today. 2015;45(5):585–94.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Chen Z, Song X, Yang D, Li Y, Xu K, He Y. Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a meta-analysis of randomized control trials. Eur J Surg Oncol. 2014;40(10):1177–85.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Xiong JJ, Tan CL, Szatmary P, Huang W, Ke NW, Hu WM, Nunes QM, Sutton R, Liu XB. Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Br J Surg. 2014;101(10):1196–208.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Hallet J, Zih FS, Deobald RG, Scheer AS, Law CH, Coburn NG, Karanicolas PJ. The impact of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction on pancreatic fistula after pancreaticoduodenectomy: meta-analysis of randomized controlled trials. HPB (Oxford). 2015;17(2):113–22.CrossRefGoogle Scholar
  24. 24.
    Ma S, Li Q, Dai W, Pan F. Pancreaticogastrostomy versus pancreaticojejunostomy. J Surg Res. 2014;192(1):68–75.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Clerveus M, Morandeira-Rivas A, Picazo-Yeste J, Moreno-Sanz C. Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. J Gastrointest Surg. 2014;18(9):1693–704.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, International Study Group of Pancreatic Surgery (ISGPS), et al. Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2017;161(5):1221–34.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Roeyen G, Jansen M, Ruyssinck L, Chapelle T, Vanlander A, Bracke B, et al. Pancreatic exocrine insufficiency after pancreaticoduodenectomy is more prevalent with pancreaticogastrostomy than with pancreaticojejunostomy. A retrospective multicentre observational cohort study. HPB (Oxford). 2016;18(12):1017–22.CrossRefGoogle Scholar
  28. 28.
    Hyodo M, Nagai H. Pancreatogastrostomy (PG) after pancreatoduodenectomy with or without duct to mucosa anastomosis for the small pancreatic duct: short and long term results. Hepatogastroenterology. 2000;47:1138–41.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Takano S, Iwai S, Tanaka T. Improved technique for pancreaticogastrostomy with implantation method after pancreaticoduodenectomy. Int Surg. 1998;83:128–30.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Takada T, Yasuda H, Uchiyama K, Hasegawa H, Misu Y, Iwagaki T. Pancreatic enzyme activity after a pylorus preserving PD reconstructed with pancreaticogastrostomy. Pancreas. 1995;11:276–82.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Yamamoto J, Shimamura Y, Nakahara H, Koishi Y, Kougo M, Ohtani H, et al. Simple technique for pancreaticogastrostomy and histologic findings of pancreaticogastric anastomosis. Arch Surg. 1997;132:785–8.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Tewari M, Shukla HS. Anterior gastrostomy technique of fashioning pancreaticogastrostomy following pancreatico-duodenectomy for pancreatic head and periampullary cancer. Indian J Surg. 2005;67:339–41.Google Scholar
  33. 33.
    Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Kantor O, Talamonti MS, Pitt HA, Vollmer CM, Riall TS, Hall BL, Wang CH, Baker MS. Using the NSQIP pancreatic demonstration project to derive a modified fistula risk score for preoperative risk stratification in patients undergoing pancreaticoduodenectomy. J Am Coll Surg. 2017;224(5):816–25.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • R. Mahendran
    • 1
  • H. S. Shukla
    • 1
  1. 1.Department of Surgical OncologyInstitute of Medical Sciences, Banaras Hindu UniversityVaranasiIndia

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