Reduction of pancreatic leak rate after pancreaticoduodenectomy by changing anastomotic and drainage techniques: a long-term single center experience

Abstract

Background: Pancreaticoduodenectomy is the best curative option for malignant pancreatic head neoplasms with a high perioperative morbidity rate. Pancreatic leak is the most feared complication. This study was done to describe our early and late experience outcomes of PD after implementing technical modifications to decrease the postoperative incidence of pancreatic leak. Methods: The data of 53 patients were collected and divided into two groups: the early experience group (27 cases) and the late experience group (26 cases). The main two modifications performed in late group were Heidelberg technique for pancreatojejunostomy anastomosis (all cases) and irrigation of the pancreatic anastomosis (selected cases). Results: All preoperative demographic, clinical, laboratory, and intraoperative findings showed insignificant differences between the two groups (p≥0.05). Nonetheless, cases in the late group had shorter operative time, less intraoperative blood loss, and less need for blood transfusion (p<0.05(. Postoperatively, the incidence of pancreatic leak decreased with technical modifications (11.54% vs. 37.04% in the early group). The late group showed earlier time to oral intake and shorter hospitalization periods. In-hospital mortality occurred in 14.81% of early cases secondary to pancreatic leak and subsequent secondary haemorrhage and multiorgan failure. Obesity (p<0.001), soft pancreas (p<0.001), and small pancreatic duct diameter (p=0.007) were significant predictors of pancreatic leak. Conclusions: Surgical expertise and technical modifications play a crucial role in improving PD outcomes with less incidence of complications, earlier oral intake, and shorter hospitalization period.