Introduction
Pancreaticoduodenectomy (PD) remains the gold-standard surgical procedure performed for both benign and malignant diseases of the pancreas and periampullary region, and the only hope of cure in such cases. Postoperative pancreatic fistula (POPF) is the most common major and serious complication after PD. The aim of this study was to identify the risk factors for pancreatic fistula after PD, and to correlate between these risk factors and the incidence of pancreatic fistula.
Patients and methods
This is a retrospective and prospective study that included all patients who underwent PD from January 2015 to May 2021. The study included 120 patients with periampullary lesions. The data were collected and statistically analyzed. One of the most serious complications in the early postoperative period is pancreatic fistula (pancreatic leak), which was defined as drain-fluid volume greater than 10 ml/day, with elevation of the drain-amylase level three times higher than the serum. The 120 patients were divided into two groups (group 1): patients who developed POPF, and (group 2): patients without POPF.
Results
The cohort of 120 cases that underwent PD comprised 80 males and 40 females, with the mean age of 51.3±8.2 years. Obstructive jaundice was the commonest symptom in 108 patients (90%), followed by weight loss in 72 patients (60%), and abdominal pain in 66 patients (55%). Postoperative complications occurred in 45 patients (38%). Pancreatic leakage occurred in 14 (12%) patients, bile leakage in seven (6%) patients, delayed gastric emptying in nine (7.5%) patients, and postoperative bleeding in 11 (9%) patients. Postoperative mortality occurred in 14 patients, eight of them were due to POPF and its related sepsis. With multivariate analysis of the significant risk factors, the authors found that soft pancreatic texture, pancreatic duct diameter less than 3 mm, operative time, and blood loss are independent risk factors for development of POPF.
Conclusion
POPF is still regarded as the most relevant and severe complication of pancreatic surgery. In this study, we found that soft pancreatic texture, pancreatic duct diameter less than 3 mm, operative time, and blood loss are independent risk factors for the development of POPF. However, more randomized studies, preferably multicenters, need to be conducted to better confirm which way of anastomosis and method of reconstruction decrease the incidence of POPF and its related mortality.