Methods of Preventing of Postoperative Complications in Patients after Pancreaticoduodenectomy

Abstract

Purpose: To develop a prevention system that allows to reduce frequency of postoperative pancreatic fistula and severe postoperative complications after pancreaticoduodenectomy. Methods: In our department results of 152 pancreaticoduodenectomy were analyzed in the period from January 2017 to November 2019. In the main group we proposed pancreatic fistula prevention system and assessment of sarcopenia that were applied in 60 patients during a year (from November 2018 to November 2019). In patients with high risk of pancreatic fistula we performed pancreato-jejunostomy with external drainage of the main pancreatic duct (stent) during the reconstructive stage after pancreaticoduodenectomy. The comparison group was comprised of 90 patients. They were operated in the period from January 2017 to October 2018 without assessment of the pancreatic fistula risk and presence of sarcopenia. Decision on the type of pancreatic anastomosis was based on surgeon's preference. Results: The level of postoperetive complications was significantly higher in the comparison group 28 (30.4%) and 9 (15.0%) in the main group (c2 = 4.7, p = 0.03). The level of postoperative pancreatic fistula grade B or C was in 17 (18.5%) in the comparison group, which is significantly higher than in the main group, where the fistula gr. B occurred in 3 (5.0%) patient (c2 = 5.8, p = 0.01). Conclusions: The developed prevention system allowed to reduce significantly the incidence of postoperative pancreatic fistula from 18.5% to 5.0% and the number of postoperative complications from 30.4% to 15.0%.