Short Internal Pancreatic Stent Reduces Pancreatic Fistula in Pancreatoduodenectomy

Abstract

Introduction: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major complication of pancreatoduodenectomy (PD). The best type of pancreatic stent for drainage of pancreatic duct remains unclear. The aim of this study was to investigate the risk factors of CR-POPF following PD. Methods: From 2006 to 2019, the records of 246 patients who underwent PD were retrospectively reviewed, and the relationship between perioperative factors including type of pancreatic stent and CR-POPF was investigated. External or internal pancreatic stents were used and the internal stent was inserted 1 cm into the jejunum to decrease obstruction of the stent (short internal stent). Results: External and internal pancreatic stent was used in 137 and 109 patients, respectively. Univariate analyses showed that BMI, thickness of the pancreas, diameter of the pancreatic duct, diagnosis, operation time, blood loss, pancreatojejunostomy method, and type of pancreatic stent were significant factors related to CR-POPF. Multivariate analysis revealed that diameter of the main pancreatic duct (OR = 0.292, 95% CI = 0.140-0.605, P = 0.001), diagnosis (OR = 3.359, 95% CI = 1.498-7.693, P = 0.003), and type of pancreatic stent (OR = 0.435, 95% CI = 0.203-0.934, P = 0.033) were independent factors related to CR-POPF. Internal stent was associated with low rate of CR-POPF (P < 0.001) and short postoperative hospital stay (P < 0.001) compared to external stent. Conclusions: Diameter of the pancreatic duct, diagnosis, and type of pancreatic stent were risk factors for CR-POPF. A short pancreatic internal stent could decrease the incidence of CR-POPF.