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Comparison of Postoperative Morphological Changes in Remnant Pancreas Between Pancreaticojejunostomy and Pancreaticogastrostomy After Pancreaticoduodenectomy

Objectives: The aim of this study was to compare postoperative morphological changes in remnant pancreas between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) after pancreaticoduodenectomy (PD). Methods: The study subjects were 28 patients with PJ and 14 with PG. The diameter of the main pancreatic duct (MPD) and pancreatic parenchymal thickness 2 years after PD were measured on computed tomography scans and compared between the 2 groups. Results: The preoperative and postoperative MPD diameter was 5.2 mm (SD, 2.4 mm) and 4.2 mm (SD, 2.0 mm) in the PJ group (P = 0.0422) and 4.8 mm (SD, 3.2 mm) and 5.7 mm (SD, 1.8 mm) (P = 0.1494) in the PG group, respectively. In those patients with preoperatively normal-size MPD, MPD after surgery tended to become dilated relative to before surgery in the PJ group (P = 0.0931), and the MPD measured postoperatively was significantly larger than preoperatively in the PG group (P = 0.0009). A significant atrophy of the pancreatic parenchyma was noted postoperatively in both groups (P < 0.0001), but these changes were more severe in the PG group than the PJ group (P = 0.0018). Conclusions: Considering the above postoperative morphological changes, PJ seems to be preferable to PG after pancreaticoduodenectomy.