Background
The pancreatic leak is the most dangerous complication
postpancreaticoduodenectomy. There are many risk factors for the development
of pancreatic fistula (PF) such as texture of the pancreas and its duct size.
The aim was to decrease the incidence of PF in these risky patients.
Patients and methods
A retrospective study was performed on 20 periampullary tumors patients treated
by subtotal pancreatectomy between April 2015 and September 2017, which were
performed in Assiut Al Rajhi Liver Hospital. Subtotal pancreatectomy was
performed in patients with soft pancreas which could not hold stitches and small
duct size of less than 3 mm. Also, the authors follow the results of postoperative
pancreatic leakage, other morbidity and mortality.
Results
A PF type A developed in three cases and did not require any further management,
one case developed PF type B who also developed delayed gastric emptying and
improved after 3 months; one case of abdominal abscess was managed by
insertion of pig tail; two cases of wound infection improved by repeated
dressing; the mean hospital stay was 7 days except for the patient who
developed PF type B and delayed gastric emptying whose hospital stay was
prolonged to 1 month; the mortality rate was one case, who was a female
patient of 70 years old and died by myocardial infarction 1 week postoperatively.
Conclusion
Subtotal pancreatectomy with stapling can be done safely in risky patients to
decrease the incidence of PF, but further large randomized trials are needed.
Keywords:
pancreatic fistula, periampullary tumors, subtotal pancreatectomy