Methods of preventing the occurrence of postoperative complications in patients with pancreaticoduodenectomy.

Background: The aim of this study was to develop a prevention system that allows to reduce frequency of pancreatic fistula and severe postoperative complications after pancreaticoduodenectomy.

Methods: The results of 143 pancreatic head resections were analyzed at our department, in the period from January 2017 to December 2019. In the main group we proposed pancreatic fistula prevention system and assessment of sarcopenia that were applied in 56 patients during a year (from November 2018 to December 2019). In patients with high risk of pancreatic fistula we performed pancreato-jejunostomy with external drainage of the main pancreatic duct (stent) during the reconstructive stage after pancreatoduodenectomy. The comparison group was comprised of 87 patients. They were operated in the period from January 2017 to October 2018 without assessment of the pancreatic fistula risk and presence of sarcopenia. Decision on the type of pancreatic anastomosis was based on surgeon's preference.

Results: The level of postoperative complications was significantly higher in the comparison group 26 (29.9%) and 7 (12.5%) in the main group (χ=5.8, P=0.01). The level of postoperative pancreatic fistula grade B or C was in 15 (17.2%) of 26 patients in the comparison group, which is significantly higher than in the main group, where the fistula gr. B occurred in 1 (1.8%) patient (χ=8.19, P=0.004).

Conclusions: The developed prevention system allowed to significantly reduce the incidence of postoperative pancreatic fistula from 17.2% to 1.8% and the number of severe postoperative complications from 29.9% to 12.5%.