Risk Factors for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy National Liver Institute Experience | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 44, Issue 2, April 2025, Page 718-726 PDF (871.32 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2024.337129.1285 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Ehab Abdelaziz Salem  ; Hesham Mohammad Abdeldayem; Essam Mohammad Salah Eldin; Mohammad Taha Badawy; Ahmed Nabil Sallam
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| Department of Hepatobiliary Surgery, National Liver Institute, Menoufia University | ||||
| Abstract | ||||
| Aim: To assess pancreatic fistula risk factors following pancreaticoduodenectomy. Methods: This was a retrospective study that included 310 consecutive cases of pancreaticoduodenectomy carried out at the National Liver institute, Menoufia University, conducted from January 1, 2015, to December 31, 2023. Results: Following pancreaticoduodenectomy, 90 (29.0%) patients of pancreatic fistula developed, comprising 18 (16.2%) grade A cases, 59 (53.1%) grade B cases, and 13 (11.7%) grade C cases. Age, hypertension, management of preoperative jaundice, preoperative levels of albumin and bilirubin, drainage of the duct of pancreas, smoking, previous upper abdominal surgery, intraoperative loss of blood and time, transfusion of blood intraoperatively (anastomosis of Braun), and pancreaticoduodenectomy were not demonstrated to be significantly correlated with POPF in the univariate analysis. Conversely, the other variables significantly correlated with POPF were diabetes (non-diabetic vs. diabetic: 38.9% vs. 61.1%, P = 0.010), gender (male vs. female: 55.6% vs. 44.4%, P = 0.671), Body mass index (BMI) (≤ 25 vs > 25: 44.4% vs 55.6%, P = 0.301), technique of panareaticojejunal anastomosis (pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis vs pancreatic-jejunum single-layer mucosa-to-mucosa anastomosis: 40.0%, vs. 55.6% P = 0.019), the pancreatic duct diameter (≤ 3 mm vs > 3 mm: 53.3% vs 46.7%, P = 0.014), and texture of pancreas (soft vs hard: 54.4% vs 45.6%, P = 0.036). Female gender, BMI greater than 25, diabetic status, and pancreatic duct diameters ≤ 3 mm were risk factors for pancreatic fistula after pancreaticoduodenectomy. Conclusion: Male gender, BMI more than 25, diabetes, a 3 mm or less diameter of pancreatic duct, soft pancreas, and double layer of mucosa to mucosa pancreaticojejunal anastomosis, , were specific factors that enhanced the possibility of pancreatic fistula after pancreaticoduodenectomy. Core tip: Our present study included 310 cases in order to elucidate the causative risk factors contributing to its development. The multivariate analysis is confirmed to be able to associate the development of the pancreatic fistula with male patients, patients whose BMI greater than 25, Diabetic patients, double-layer Mucosa-Mucosa pancreatojejunostomy. | ||||
| Keywords | ||||
| Complications; Pancreatic fistula; Pancreaticojejunal anastomosis; Pancreaticoduodenectomy | ||||
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