الفهرس 
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Abstract
Aim of the work : This single center prospective study was designed to evaluate the results of pancreaticogastrostomy as a method of pancreatic reconstruction after pancreaticoduodenectomy for different indications as regards the hospital mortality, morbidity; and physiological changes after this major resection; namely pancreatic exocrine function and gastric emptying.
Patients & methods :
The study included 74 pancreaticoduodenectomy patients. All of these patients underwent thorough history taking, clinical examination, complete laboratory investigations, conventional abdominal ultrasonography. Triphasic abdominal CT was performed for 73 (98.6%) patients whereas ERCP was performed for 50 (67.6%) of patients. Laparoscopy has not been a component of our staging workup for periampullary masses. The mean age mean age was 52 (±11) years (median = 53). Male to female ratio was 2:1. Results: All patients underwent Whipple’s pancreaticoduodenectomy with pancreaticogastrostomy. Five (6.8%) patients died in hospital. Twenty-eight (37.8%) patients developed one or more complication. Pancreatic leak delayed gastric emptying (DGE), bile leak, abdominal collection and wound infection each occurred in seven (9.5%) patients. Four (5.5%) patients required reoperation. The mean length of hospital stay was 11 ± 7 days (median = 9, range = 6 - 45). The following factors differed significantly between patients with and without DGE: the incidence of postoperative complications, other than DGE, intraabdominal collection and reoperation. Gastric emptying time (GET) more than 84 minutes was considered as the upper limit for normal gastric emptying. The mean preoperative value was 75.3 (±16.4) min (median = 70 min, range = 55 - 100). Early postoperatively the mean value increased to 92.6 (±16.4) min (median = 85, range = 60 - 150). The mean gastric emptying time reduced to 73 (±16.1) min (median = 70, range = 50 - 130) by four months. There was a significant difference between the early postoperative results and results of the control group (p= <0.0001). There was no significant difference between the preoperative (p= 0.148) and the late postoperative results (p= 0.233) of the study group and that of the control group. The GET increased significantly (p= <0.0001) in the early postoperative period. This was followed by a significant decrease (p= <0.0001) after 4 months postoperatively. There was no statistically significant difference between the preoperative values and that after four months. Faecal elastase-1 concentrations were analysed in 30 patients. Faecal elastase-1 level less than 200 µg / g was considered in this study to be diagnostic for pancreatic exocrine insufficiency. The mean preoperative value was 165.4 (±124) µg/g (median = 130, range = 35 - 550). Two weeks postoperatively the mean value increased to 277.1 (±125.6) µg/g (median = 290 µg/g, range = 50 -550). The mean faecal elastase-1 value reached 310.2 (±155.2) µg/g (median = 287.5, range = 60 - 575) by four months. There was a statistically significant difference between the preoperative results, early postoperative results and results of the control group (p= <0.0001) and (p= 0.005), respectively. By four months the levels of faecal elastase-1 of the study group were less than but with no significant difference from the control group (p=0.062). Fecal elastase-1 levels increased significantly (p= <0.0001) at one and four months postoperatively. There was no statistically significant difference between the values immediately postoperative and within four months. Conclusion: from this study we concluded that pancreaticogastrostomy after pancreaticoduodenectomy is a safe and effective reconstruction method. However, it is associated with significant changes related to gastro-intestinal physiology. These changes recede with time and patients reach a near normal life style.