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INTRODUCTION:While perioperative complications of pancreaticoduodenectomy(PD) have been well documented, long-term complications of PD have not been well characterized. In this study, we investigate complications experienced by patients status post PD with pancreaticogastrostomy (PG) reconstruction more than 12 months after the procedure. METHODS:We performed a retrospective review of patients who underwent PD with PG more than 12 months prior the study period. Data was collected by chart review as well as a mailed survey. We performed a retrospective analysis assessing the incidence of new diagnoses of diabetes mellitus (DM) and the use of pancreatic enzyme replacement in patients more than one year after PD at a single institution from 1990 to 2010. The main outcome measures were a diagnosis of DM based on random and fasting blood glucose measurements, and patients’ requirements for pancreatic enzyme replacement for control of steatorrhea and malabsorption. RESULTS:Our cohort included 92 patients who underwent PD with PG more than 12 months prior to the beginning of the study. The median length of follow up was 4.2 years after the procedure. Preoperative diagnoses included periampullary tumors in 59 (63%) of the patients, cystic tumors in 14 (15%) of the patients, neuroendocrine tumors in 9 (10%) of the patients, chronic pancreatitis in 6 (7%) of the patients, and other pathology in 5 (5%) of the patients. Of the 92 patients, 45 (48.9%) now require pharmacologic therapy with pancrelipase for symptoms of steatorrhea and malnutrition. Twelve patients had been diagnosed with diabetes mellitus prior to undergoing the procedure and were excluded from the second part of the study; of the remaining 80 patients, 18 (23%) became diabetic after the procedure. Seven of these patients (39%) now require insulin therapy for diabetes management, while twelve (67%) are controlled on oral pharmacologic agents only. In total, 20 of the 92 patients underwent adjuvant chemotherapy and 19 underwent adjuvant radiation therapy. Of the 18 patients who developed diabetes, 5 (28%) underwent adjuvant chemotherapy and 4 (22%) underwent adjuvant radiation therapy. Of the 45 patients who now require pancrelipase therapy, 11 (24%) underwent adjuvant chemotherapy and 11 (24%) underwent adjuvant radiation therapy. CONCLUSIONS:Symptomatic malabsorption requring pancreatic enzyme therapy is a long-term complication of PD with PG. These patients should be monitored for malabsorption. After PD with PG, patients are as likely as the general population to develop diabetes mellitus.