Outcomes of Pancreatic Fistula After Pancreaticoduodenectomy

Abstract

Background: The occurrence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a major contributor to morbidity and mortality. Hence, it is imperative to decrease the occurrence of clinically significant POPF to enhance the overall morbidity outcomes associated with PD. This study seeks to assess the outcomes of pancreatic fistula following PD.

Methods: This study was a combined prospective and retrospective analysis of patients who underwent PD at Al-Thawra Modern General Hospital between January 2016 and April 2021. A total of 42 patients were included in the analysis.

Results: Among the 42 patients who underwent PD, 40% were male and 60% were female. The age distribution showed that 5% of patients were under 20, 14% were between 20 and 40, and 81% were above 40. The primary indications for PD were malignant periampullary tumors in 83.3% of patients, solid pseudopapillary tumors of the pancreas in 7.1% of patients, chronic pancreatitis in 4.76% of patients, duodenal adenocarcinoma in 2.38% of patients, and trauma in 2.38% of patients. Among the patients, 30 (71.43%) had a successful recovery without evidence of pancreatic fistula (PF), whereas 12 (28.57%) developed POPF. Among the 12 patients with POPF, 3 (7.14%) had a biochemical leak, 5 (11.9%) had a grade B fistula, and 4 (9.53%) had a grade C fistula according to the revised ISGPS definition. Of the patients with POPF, those with a biochemical leak did not experience significant morbidity and were managed conservatively. Patients with grade B fistula (5 patients) had an extended hospital stay of approximately 2-3 weeks and received percutaneous drainage as an intervention. One patient (8.33%) with grade C fistula required reoperation because of bleeding, and 3 patients (25%) developed septic shock and subsequently died, resulting in an overall mortality rate of 25% among patients with POPF.

Conclusion: POPF following PD remains a serious complication of substantial morbidity and mortality. Further improvements in the prevention, early detection, and management of POPF are necessary to reduce postoperative morbidity and mortality. Using the ISGPS definition and grading of PF aids in the clinical assessment and management of PF.