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World Journal of Surgery
Published in: World Journal of Surgery 6/2013

01-06-2013

Pancreatic Anastomotic Leakage after Pancreaticoduodenectomy. Risk factors, Clinical predictors, and Management (Single Center Experience)

Authors: Ayman El Nakeeb, Tarek Salah, Ahmad Sultan, Mohamed El Hemaly, Waleed Askr, Helmy Ezzat, Emad Hamdy, Ehab Atef, Ehab El Hanafy, Ahmed El-Geidie, Mohamed Abdel Wahab, Talaat Abdallah

Published in: World Journal of Surgery | Issue 6/2013

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Abstract

Background

Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a challenge even at high-volume centers.

Methods

This study was designed to analyze perioperative risk factors for POPF after PD and evaluate the factors that predict the extent and severity of leak. Demographic data, preoperative, intraoperative, and postoperative variables were collected.

Results

A total of 471 consecutive patients underwent PD in our center. Fifty-seven patients (12.1 %) developed a POPF of any type; 21 patients (4.5 %) had a fistula type A, 22 patients (4.7 %) had a fistula type B, and the remaining 14 patients (3 %) had a POPF type C. Cirrhotic liver (P = 0.05), BMI > 25 kg/m2 (P = 0.0001), soft pancreas (P = 0.04), pancreatic duct diameter <3 mm (0.0001), pancreatic duct located <3 mm from the posterior border (P = 0.02) were significantly associated with POPF. With the multivariate analysis, both BMI and pancreatic duct diameter were demonstrated to be independent factors. The hospital mortality in this series was 11 patients (2.3 %), and the development of POPF type C was associated with a significantly increased mortality (7/14 patients). The following factors were predictors of clinically evident POPF: a postoperative day (POD) 1 and 5 drain amylase level >4,000 IU/L, WBC, pancreatic duct diameter <3 mm, and pancreatic texture.

Conclusions

Cirrhotic liver, BMI, soft pancreas, pancreatic duct diameter <3 mm, pancreatic duct near the posterior border are risk factors for development of POPF. In addition a drain amylase level >4,000 IU/L on POD 1 and 5, WBC, pancreatic duct diameter, pancreatic texture may be predictors of POPF B, C.
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Metadata
Title
Pancreatic Anastomotic Leakage after Pancreaticoduodenectomy. Risk factors, Clinical predictors, and Management (Single Center Experience)
Authors
Ayman El Nakeeb
Tarek Salah
Ahmad Sultan
Mohamed El Hemaly
Waleed Askr
Helmy Ezzat
Emad Hamdy
Ehab Atef
Ehab El Hanafy
Ahmed El-Geidie
Mohamed Abdel Wahab
Talaat Abdallah
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 6/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-1998-5

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