Introduction : Postoperative pancreatic fistula (POPF) is the most important morbidity after pancreaticoduodenectomy (PD). However, the best reconstruction method to reduce occurrence of fistula is not conclusive, especially in high risk gland for POPF. To examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce POPF, after PD according to Fistula Risks.

Methods : Retrospective analysis of prospectively collected data of 134 patients who underwent PG (81, 60.4%) and PJ (53, 39.6%) reconstruction between January 2002 and December 2016 in single institution.

Results : Overall POPF occurred in 22 (16.4%). POPF rate was 17.2% (n=14) in the PG group and 15.1% (n=8) in the PJ group (P = 0.466). In High risk group (n=45) for POPF, there was 3 (18.8%) POPF in PJ group and 9 (31.0%) in PG group, respectively (p=0.30). POPF rate were not different in moderate, low and negligible risks between two reconstructive methods. There were also no significant differences of other morbidity such as post pancreatic hemorrhage, intra abdominal abscess, delayed gastric emptying and mortality between two groups.

Conclusions : In PD, there was no superior method of reconstruction with regards to POPF, even in high risk glands.