Objective: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following   pancreaticoduodenectomy   in   a   prospective   randomized   trial.
Background: Pancreatic leak and fistula are the most leading cause of morbidity and mortality after pancreaticoduodenectomy. Many reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with pancreatic leak. However, other trials have reported no difference inbetween both groups.
Methods: All patients undergoing pancreaticoduodenectomy in Ain Shams Hospitals between May 2004 and June 2009 were randomized to one of two groups  in the reconstructive phase of the operation, either pancreaticogastrostomy or pancreaticojejunostomy group .
Main outcome measures: Mortality and morbidity following pancreaticogastrostomy and pancreaticojejunostomy, especially pancreatic anastomotic leakage.
Results: 33 patients underwent pancreaticoduodenectomy. Of these 18 had pancreaticogastrostomy and 15 had pancreaticojejunostomy. There were 20 males and 13 females with a mean age of 57.4 years. There were no significant differences between groups on comparison of preoperative data, patient's characteristics and operative parameters except that the operative time and blood transfusion were insignificantly higher in PG group. Postoperatively, the mortality and morbidity rates did not differ between the PG and PJ group. The rate of pancreatic leak was not significantly different between both groups. However, the overall complications were higher in pancreaticojejunostomy. Pancreatic leak was found to be higher in patients with soft pancreas, small pancreatic duct, and to a lesser extent in elderly patients, long operative time and higher intraoperative blood loss.
Conclusion: Pancreaticogastrostomy is safer than pancreaticojejunostomy after pancreaticoduodenectomy. Some important factors such as surgeon's experience, pancreatic texture,  size of the pancreatic duct and to a lesser extent; patient's age, operative time and intraoperative blood loss play a contributory role in pancreatic anastomotic leakage.
Key words: Pancreaticoduodenectomy, pancreaticogastrostomy, pancreaticojejunostomy