The operative mortality rate after pancreaticoduodenectomy (PD) is 5% or less at major surgical centers and is generally related to pancreatic anastomosis complications. Recently, several authors have reported a low incidence of complications after PD using pancreaticogastrostomy. The aim of our work was to retrospectively study the operative complications of pancreaticogastrostomy (PG) and pancreaticojejeunostomy (PJ) after PD. Since 1989 we have performed 59 consecutive DP, in 33 male patients and 22 female patients, with a mean age of 56 +/- 12 years. We performed 43 PG and 16 PJ. In 42/59 cases, PD was performed for malignant disease. Pancreaticoduodenal resection was identical in both groups, with classical pancreatic transection performed at the level of the mesentericoportal axis. The overall mortality rate in this study was 5.08% (n = 3). It was 4.65% (n = 2) in the PG group and 6.25% (n = 1) in the PJ group. Operative complications were absent in 36 patients (24 PG, 12 PJ). The mean postoperative hospital stay was 17 +/- 6 days; 23 patients (19 PG, 4 PJ) presented one or several complications. 12 patients required re-exploration (10 PG, 2 PJ). Pancreatic fistula occurred in 8 patients (13.55%), 14% (n = 6) in the PG group and 12.5% (n = 2) in the PJ group. In each group, only one pancreatic fistula was re-explored. Seven patients (16%) in the PG group presented postoperative pancreatitis. Pancreatic fistula and postoperative pancreatitis occurred in a pancreas with a normal texture and non-dilated pancreatic duct in every case, with one exception (PJ). During long term follow-up, 18 patients died from cancer (12 PG, 6 PJ). In conclusion, this study suggests that PG does not decrease the pancreatic fistula or postoperative pancreatitis rates and that these complications are essentially related to pancreatic texture and pancreatic duct.