Early Complications of Internal Versus External Pancreatic Duct stent in Patients with Pancreaticoduodenectomy

Background: Pancreaticoduodenectomy (PD) is a complex surgical procedure with significant postoperative complications, including pancreatic fistula, delayed gastric emptying, and intra-abdominal infections. This study aims to compare the early postoperative complications of internal versus external pancreatic duct stents in patients undergoing PD. Material & Methods: This prospective observational study was conducted at Dhaka Medical College Hospital from January 1, 2023, to December 27, 2023. A total of 40 patients scheduled for PD were divided into two groups: 20 managed with internal stents and 20 with external stents. Data on demographic characteristics, per-operative factors, and postoperative complications were collected and analyzed. Results: The study population had a mean age of 56.78 years, with males constituting 65%. The most common histopathological diagnosis was periampullary carcinoma (50%). In the internal stenting group, 10% had a soft pancreas, 65% had a firm pancreas, and 25% had a hard pancreas. In the external stenting group, 40% had a soft pancreas, 50% had a firm pancreas, and 10% had a hard pancreas. Wound infections occurred in 10% of the internal stenting group and 15% of the external stenting group. Intra-abdominal collections were found in 5% of the internal stenting group and 10% of the external stenting group. GI bleeding was absent in the internal stenting group but occurred in 5% of the external stenting group. Intra-abdominal bleeding was absent in the internal stenting group but present in 10% of the external stenting group. Delayed gastric emptying was noted in 5% of participants in both groups. Grade A pancreatic fistula was observed in 10% of the internal stenting group and 15% of the external stenting group. Grade B and C pancreatic fistulas were only present in the external stenting group, at rates of 10% and 5%, respectively. Conclusions: Internal pancreatic duct stents are associated with lower incidences of wound infections, intra-abdominal collections, and severe pancreatic fistulas compared to external stents. These findings suggest that internal stents may offer better postoperative outcomes, although stent selection should be individualized based on patient-specific factors. Further research is warranted to confirm these results and guide clinical practice.