Anatomy at Pancreatic Transection Point in Predicts Occurrence of Postoperative Pancreatic Fistula

Abstract

Introduction Postoperative pancreatic fistula is a dreaded complication following pancreatic head resections. There are many variables which predict occurrence of pancreatic fistula we analysed the anatomical factors at the pancreatic transection to predict occurrence of pancreatic fistula. Materials and Methods It is a prospective observational study done from 2014 July to 2015 December. Eighty patients were included, intraoperatively we measured the anteroposterior thickness, cranio caudal thickness and thickness anterior, posterior, cranial and caudal to duct. We correlated these anatomical factors with postoperative complications. Results POPF was seen in 19 patients (23.75%) of which clinically significant fistula was seen in 5 patients (6.25%) and biochemical fistula is seen in 14 patients (17.5%). As the parenchymal thickness cranial to duct increased the chance of POPF increased (mean ± SD-15.26 ± 3.03 mm, p=0.014). As the thickness anterior to duct increases (7.18 ± 1.50 mm, p=0.023) and mean thickness posterior to duct decreases (5.34 ± 3.32 mm, p=0.036) chance of POPF increased. Clinically relevant fistula was significantly seen to be related with thickness anterior to duct, at a thickness >6.5 mm sensitivity of occurrence of fistula 68.4% and specificity was 74%. Conclusions At the transaction point when the thickness anterior to duct increases chances of clinically relevant fistula increases. As the thickness anterior to duct increases duct would be positioned more posteriorly creating difficulty while placing sutures.