Sajida Qureshi
Dow University of Health Sciences, Pakistan
Title: Stented pancreaticoduodenectomy: Does it lead to decreased pancreatic fistula rates??
Biography
Biography: Sajida Qureshi
Abstract
Introduction: Pancreaticoduodenectomy (Whipple procedure) is a treatment of choice for patients with resectable carcinoma head of pancreas, lower cholangiocarcinoma, duodenal and ampullary and periampullary carcinomas. One of the much-dreaded complications of pancreaticoduodenectomy is pancreatic anastomotic leak leading to the pancreatic fistula formation, which can lead to septicemia and resultant complications leading to death of the patient. Stenting the pancreaticoenteric anastomosis has been postulated as reducing the pancreatic anastomotic leak and fistula rates up until now there is no convincing evidence supporting this fact.
Objective: To compare clinically relevant pancreatic fistula rates in patients with stinted versus non-stinted pancreaticojejunostomy.
Material & Methods: The study was conducted at Surgical Unit of 4 civil hospitals in Karachi, Pakistan, over a period of six years from September 2009 to August 2015. A total of 102 patients presenting to the unit with diagnosis of periampullary carcinoma, carcinoma head of pancreas, duodenal carcinoma involving the second part, and lower cholangiocarcinomas resectable on CT scan were included in the study. The primary study end point was pancreatic fistula or leakage, defined as amylase rich fluid (amylase concentration >3 times the upper limit of normal serum amylase level) collected from the peripancreatic drains on day 1, 3 and 7 post operatively which persisted beyond five days.
Results: A total of 102 patients were included in the study. Male to female ratio was (72:30). Mean age of the study population was 52.68 years, SD 11.6 (range 30-80 years) 53 patients had Pd stent (51.9%) while 49 did not have stented pancreaticojejunostomy (48%). Anastomotic leak was seen in 36 patients (35%). 37.7% patients with pancreatic stent and 32.6% patients without stent had a leak (p value 0.371).
Conclusion: There was no statistically significant difference in the pancreatic fistula rates between stinted and non-stinted anastomosis. We conclude that stinted pancreaticojejunostomies do not lead to decreased pancreatic fistula rates.
