Pancreatic fistula after pancreaticoduodenectomy. Pancreaticogastrostomy vs. pancreaticojejunostomy

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Gustavo Nari
Lucas Granero
Jorge Silva
José Layún
Daniela Mariot
Natalia Duran
Eugenio Cecchetto
Lucas Viotto
Soledad Arzac


Background: Pancreaticoduodenectomy is still the treatment of choice in patients with periampullary tumors. Pancreatic fistula is the most common complication with a mortality rate of 5% and 50% of morbidity. Some authors state that the anastomosis of the pancreas with the stomach would decrease the incidence of pancreatic fistula when compared with pancreaticojejunostomy.
Objective: The aim of this study was to compare the incidence of pancreatic fistula after pacreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) and analyze the risk factors associated with the development of fistula.
Material and methods: 91 patients undergoing pancreaticoduodenectomy were evaluated; 43 with PG reconstruction and 48 with PJ reconstruction. Demographic and surgical data were evaluated and the incidence of pancreatic fistula with both techniques was compared
Results: The incidence of fistula for the total series was 14.3% (n = 13) and 5 were clinically relevant. There were differences in age and pancreatic duct diameter < 3 mm between the groups. The incidence of fistula was similar in both groups (p = 0.478). Pancreatic duct diameter < 3 mm was the only significant predisposing factor for the development of fistula.
Conclusion: In our series, and in coincidence with others, there were no differences in the incidence of pancreatic fistulas between PG and PJ. Practicing and mastering a repetitive, standardized technique would yield the best results.


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Nari, G., Granero, L., Silva, J., Layún, J., Mariot, D., Duran, N., Cecchetto, E., Viotto, L., & Arzac, S. (2021). Pancreatic fistula after pancreaticoduodenectomy. Pancreaticogastrostomy vs. pancreaticojejunostomy. Revista Argentina De Cirugía, 111(2), 79–89. Retrieved from
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