Postpancreatectomy Hemorrhage after Pancreaticogastrostomy compared to Pancreaticojejunostomy: A single-center prospective cohort study in 274 patients

Context: Postpancreatectomy hemorrhage and postoperative pancreatic fistula are major causes of morbidity and mortality after pancreaticoduodenectomy. This single center prospective cohort study compares postpancreatectomy hemorraghe after pancreaticogastrostomy and pancreaticojejunostomy. Our hypothesis is that postpancreatectomy hemorraghe after pancreaticogastrostomy is more prevalent and severe. Design: Between January 2013 and March 2021, data on all patients undergoing pancreaticoduodenectomy were collected prospectively. In 2013, pancreaticogastrostomy was implemented as the reconstruction technique for all patients. However, due to a high incidence of severe postpancreatectomy hemorraghes the reconstruction technique was changed to pancreaticojejunostomy in 2016. The anastomosis remained consistent between the two methods, utilizing interrupted sutures with a "dunking" technique. Results: The risk for postpancreatectomy hemorraghe increases by 5.6 times when postoperative pancreatic fistula occurs (OR=5.60 95% CI [2.21-15.08], p<0.001). After correcting for postoperative pancreatic fistula, the odds on a grade C postpancreatectomy hemorraghe is 6.91 (95% CI [2.96-17.67], p<0.001) times higher after pancreaticogastrostomy, compared to pancreaticojejunostomy. Resulting in more relaparotomies after pancreaticogastrostomy (28.6%), compared to 8.4% after pancreaticojejunostomy ( p<0.001). Conclusions: Pancreaticogastrostomy has been proposed as a safer reconstruction technique after pancreaticoduodenectomy with less postoperative pancreatic fistula. However, no significant difference in postoperative pancreatic fistula was observed in this study. The severity and incidence of grade C postpancreatectomy hemorraghe were significantly higher after pancreaticogastrostomy compared to pancreaticojejunostomy, resulting in a higher number of relaparotomies.