External stenting of pancreaticojejunostomy anastomosis and pancreatic duct after pancreaticoduodenectomy

Lileswar Kaman, Syed Nusrath, Divya Dahiya, Ajay Duseja, Sameer Vyas, Vikas Saini

Pancreatic fistula is a major cause of morbidity and mortality after pancreaticoduodenectomy. External drainage of pancreaticojejunostomy anastomosis with a stent is used to reduce the rate of pancreatic fistula. This study compares the rates of pancreatic fistula between external stent drainage versus no-stent drainage for pancreaticojejunal anastomosis following pancreaticoduodenectomy. A total of 53 patients undergoing pancreaticoduodenectomy for various benign and malignant pathologies were included in the study. An external stent was inserted across the anastomosis to drain the pancreatic duct in 26 patients and 27 patients received no stent. The primary end point was pancreatic fistula. All surgeries were done by a single surgeon with expertise in hepatobiliary pancreatic surgery at a single institute. The two groups were comparable in demographic data, underlying pathologies, presenting complaints, presence of comorbid illnesses and proportion of patients with preoperative biliary drainage, pancreatic consistency and duct diameter. The pancreatic fistula rates were similar in both the groups (11.5 vs. 14.8 %, P = 0.725). The morbidity and surgical re-exploration rate were statistically not significant between the two groups (65.4 vs. 51.9 %, P = 0.318 and 11.5 vs. 7.4 %, P = 0.60). Postoperative stay was also similar with a mean of 14 days in both the groups (P = 0.66). The mortality rate was statistically not significant in the two groups (3.8 vs. 7.4 %, P = 0.575). External drainage of pancreaticojejunostomy anastomosis and the pancreatic duct with a stent does not decrease the rate of postoperative pancreatic fistula after pancreaticoduodenectomy.