Stenting and the rate of pancreatic fistula following pancreaticoduodenectomy.

Abstract

OBJECTIVE:

To evaluate the efficacy of transanastomotic pancreatic duct internal stenting in the reduction of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.

DESIGN:

Retrospective study.

SETTING:

Mayo Clinic.

PATIENTS:

Between January 1, 1999, and September 30, 2010, 553 patients underwent pancreaticoduodenectomy by a single surgeon.

MAIN OUTCOME MEASURES:

Rates of POPF, morbidity, and mortality between stent and no-stent groups.

RESULTS:

The clinically relevant POPF (International Study Group on Pancreatic Fistula definition grade B or C) rates in the stent and no-stent groups were similar (9.6% [43 of 449 patients] and 12.5% [13 of 104 patients], respectively; P = .38). Postoperative outcomes and morbidity were also similar between the 2 groups. Mortality was 0.7% (3 of 449 patients) for the stent group and 1.0% (1 of 104 patients) for the no-stent group. Four patients (0.9%) required endoscopic retrieval of the anastomotic stent. In subset analysis, the clinically relevant POPF rates in patients with a small pancreatic duct (≤3 mm; n = 167) were similar in the stent and no-stent groups (17.7% [23 of 130 patients] and 24.3% [9 of 37 patients], respectively; P = .38). In patients with a soft pancreatic gland (n = 64), rates of clinically relevant pancreatic fistulae were also similar in the stent and no-stent groups (31.7% [13 of 41 patients] and 17.4% [4 of 23 patients], respectively; P = .20).

CONCLUSIONS:

Internal transanastomotic pancreatic duct stenting does not decrease the frequency or severity of POPF. The effect of stenting on long-term anastomotic patency warrants further investigation.

• Authors: Toshiyuki Moriya, Clancy J Clark, Yujiro Kirihara, Michael L Kendrick, Kaye M Reid Lombardo, Florencia G Que, Michael B Farnell
• Journal: Archives of surgery (Chicago, Ill. : 1960) (Arch Surg) Vol. 147 Issue 1 Pg. 35-40 (Jan 2012) ISSN: 1538-3644 [Electronic] United States
• PMID: 22250109 (Publication Type: Journal Article)

Topics

• Aged
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Fistula (epidemiology, etiology, prevention & control)
• Pancreaticoduodenectomy (adverse effects, methods)
• Retrospective Studies
• Stents