Background/aims: The main purpose of this study was to try to provide the indirect evidence of protection against marginal ulceration by neutralizing the gastric acidity with alkaline pancreatic secretions following non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (PPPD-PG). Safety of the non-stented PPPD-PG was also evaluated and reviewed.
Methodology: Twenty-five patients with resectable periampullary lesions undergoing non-stented PPPD-PG were recruited for study. Gastric pH and amylase levels were measured on postoperative day 7. Morbidity, pancreatic leakage and mortality were also evaluated.
Results: The median values of gastric pH and amylase following non-stented PPPD-PG group were both statistically higher than those of healthy control group (pH, 6.3 vs. 2.8; amylase, 26,300 vs. 21 IU/L). The overall complication rate was 24.0%. Gastric atonia was the most common complication, occurring in 4 (16%) patients. No pancreatic leakage or ulcer-related complication such as upper gastrointestinal bleeding or perforation occurred in patients after non-stented PPPD-PG. There was 1 (4.0%) death, which was secondary to cardiac arrhythmia, but not related to operation.
Conclusions: Non-stented PPPD-PG could increase gastric pH and amylase levels, which might provide protection against marginal ulceration. No pancreatic leakage, and low morbidity and mortality confirm that non-stented PPPD-PG could be a relatively safe and reliable alternative in the pancreatic reconstruction after pancreaticoduodenecomy.