Factors affecting healing time of postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy

Clinically-relevant postoperative pancreatic fistula (CR-POPF) is one of the most serious complications following pancreaticoduodenectomy. While many investigators have studied risk factors for the development of CR-POPF, few studies have focused on time needed for CR-POPF healing in patients who develop this complication. The present study enrolled 38 cases in whom CR-POPF developed following pancreaticoduodenectomy (24.1%) out of 158 cases receiving treatment with pancreaticoduodenectomy between 2009 and 2017 for periampullary diseases. CR-POPF healing time, was defined as the length of time from the day of pancreaticoduodenectomy to the day when intraabdominal drainage tubes used for CR-POPF treatment were removed, were assessed and factors affecting the healing time were investigated. The mean CR-POPF healing time was 40.2±21.7 days (median; 35 days, range; 10-110 days). Univariate analysis demonstrated a significant relationship between CP-POPE healing time and sex, intraoperative blood loss, and type of pancreaticojejunostomy procedure. Multivariate Cox regression analysis using these factors revealed that intraoperative blood loss and type of pancreaticojejunostomy procedure were significant independent factors for the length of CR-POPF healing time. CR-POPF healing time following pancreaticoduodenectomy was 40.2±21.7 days on average (median, 35 days; range 10-110 days). Intraoperative blood loss and type of pancreaticojejunostomy procedure were identified as significant independent factors associated with the healing time. These results will help with earlier recovery from CR-POPF.

Modified Blumgart anastomosis without pancreatic duct-to-jejunum mucosa anastomosis for pancreatoduodenectomy: a feasible and safe novel technique

Objective

This study proposed a modified Blumgart anastomosis (m-BA) that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis, with the aim of simplifying the complicated steps of the conventional BA (c-BA). Thus, we observe if a difference in the risk of postoperative pancreatic fistula (POPF) exists between the two methods.

Methods

The m-BA anastomosis method has been used since 2010. From October 2011 to October 2015, 147 patients who underwent pancreatoduodenectomy (PD) using BA in Tianjin Medical University Cancer Institute and Hospital were enrolled in this study. According to the type of pancreatojejunostomy (PJ), 50 patients underwent m-BA and 97 received c-BA. The two patient cohorts were compared prospectively to some extent but not randomized, and the evaluated variables were operation time, the incidence rate of POPF, and other perioperative complications.

Results

The operation time showed no significant difference (P > 0.05) between the two groups, but the time of duct-to-mucosa anastomosis in the m-BA group was much shorter than that in the c-BA group ( P < 0.001). The incidence rate of clinically relevant POPF was 12.0% (6/50) in the modified group and 10.3% (10/97) in the conventional group ( P > 0.05), which means that the modified anastomosis method did not cause additional pancreatic leakage. The mean length of postoperative hospital stay of the m-BA group was 23 days, and that of the c-BA group was 22 days ( P > 0.05).

Conclusions

Compared with the conventional BA, we suggest that the modified BA is a feasible, safe, and effective operation method for P J of PD with no sacrifice of surgical quality. In the multivariate analysis, we also found that body mass index (≥ 25 kg/m²) increased the risk of POPF.