To evaluate the outcome of pancreaticogastrostomy in terms of the course in hospital stay and post-operative complications

Abstract

Background: Pancreaticogastrostomy (PG) is often used to reconstruct the pancreatic stump after Whipple surgery, and this procedure is burdened by a non-negligible rate of post-operative pancreatic fistula (POPF).

Aims and Objectives: The present study was done to evaluate the outcome of PG in terms of the course in hospital stay and post-operative complications.

Materials and Methods: This prospective observational study was done in a tertiary care hospital in 26 patients over a 2-year period after ethical committee clearance. All data is formulated in frequency and charts. All patients with indications for pancreatoduodenectomy were enrolled in this study.

Results: Average age of the study population was 53.3±7.9 years. Jaundice (84.6%) and pain in the abdomen (80.8%) were the most common clinical presentations. On post-operative day 1 (POD1), drain fluid amylase was raised in 23% of cases, which reduced to 19% on day 3 and day 5. The biochemical leak (Grade A) was observed in 2 cases. The incidence of POPF was 11.5%, delayed gastric emptying was 11.5%, intrabdominal collections/abscess was 7.7%, and wound infection was 11.5%. Need for re-exploration and mortality was observed in one case. Pancreatic fistula incidence (23.07%) was significantly higher in pancreas duct size <3 mm (P<0.05) and pancreatic neck thickness <1 cm.

Conclusion: Amylase level in the abdominal drainage fluid on POD1 and serum amylase level on POD4 represent novel biomarkers associated with POPF development. Pancreatic fistula incidence was higher in pancreas duct size <3 mm and pancreatic neck thickness <1 cm.