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Category: Volume 08 Issue 01 January 2020
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Title: Postoperative Pancreatic Fistula following Pancreaticoduodenectomy for Periampullary Carcinoma – A Comparative study

Authors: Dr Chaithanya Babu Bogarapu, Dr Munagavalasa Aditya Ram, Dr Chintagada Jayaraj, Dr Vadisetti Satya Niharika, Dr Kiran Kumar Miriyam, Dr Divya Yaganti, Dr Yannam Sambasiva Rao

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.106

Abstract

Background: Postoperative Pancreatic Fistula (POPF) formation is an important complication following pancreatic resections. International Study Group on Pancreatic Fistula (ISGPF) has defined POPF as ‘an abnormal communication between pancreatic ductal epithelium and another epithelial surface, containing pancreas derived enzyme-rich fluid.’ Although Pancreatic Fistula (PF) is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or maybe life-threatening and necessitate emergency reoperation (grade C).

This study aims to compare the incidence of POPF after pancreatico-duodenectomy (PD) following duct-to-mucosa and dunking methods.

Materials and Methods: A total number of 48 patients diagnosed with periampullary carcinoma attending to OPD, King George Hospital from August 2017 to August 2018 are included. All the patients were subjected to routine blood investigations and imaging studies. Cases were randomized based on block randomization. Postoperatively biochemical and imaging studies done for leak identification. Patients who didn’t give their consent and who succumbed immediately postoperatively were excluded.

Results: Of the 48 cases who underwent PD, 24 underwent pancreaticojejunostomy using duct to mucosa method, rest with invagination or dunking method. Three cases developed POPF following surgery (6.23%). Of these, two (8.33%) following duct-to-mucosa and one (4.16%) following the invagination method. All three managed conservatively. No mortality due to POPF.

Conclusion: POPF continues to be the nemesis of pancreatic resection. Many technical variations have been developed with the hope of decreasing the incidence of POPF. In a nutshell, a successful pancreatico-enteric anastomosis requires a tension-free anastomosis with adequately placed and tied sutures, preserved blood supply to the pancreatic remnant and jejunum, and unobstructed flow from the pancreas into the gastrointestinal tract, whatever the chosen technique may be.

Keywords: Postoperative Pancreatic fistula-pancreaticojejunostomy-Whipple’s procedure.

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Corresponding Author

Dr Chintagada Jayaraj

Professor & Head of the Department of Surgery, Andhra Medical College, Visakhapatnam, India