Postoperative pancreatic fistula and postpancreatectomy acute pancreatitis: influence on the clinical course of the postoperative period and outcomes in patients after pancreaticoduodenectomy

Annotation. Pancreaticoduodenectomy (PD) is one of the most difficult surgical interventions in abdominal surgery. Particularly important complications of PD are postoperative pancreatic fistula (POPF) and postpancreatectomy acute pancreatitis (PPAP), which have a significant impact on the clinical course of the postoperative period, hospitalization duration, risk of infectious complications, and overall health outcomes. The study was based on the analysis of 296 cases of patients who underwent PD in the period from 2014 to 2023. The criteria of the International study group on pancreatic surgery (ISGPS) were used to diagnose PPAP. Patients were divided into four groups according to the presence or absence of POPF and PPAP. The data obtained were processed by statistical methods using SPSS. Among 296 patients who underwent PD, POPF developed in 42,2% of cases, and PPAP - in 42,6%. Patients with a combination of POPF and PPAP had the worst rates of postoperative complications, more often required repeated interventions, and stayed in the hospital longer. The group with isolated POPF, but without PPAP, demonstrated the highest incidence of serious complications (bleeding, sepsis, multiple organ failure). The lowest complications were observed in the group without POPF and PPAP. Thus POPF and PPAP significantly worsen the course of the postoperative period in patients after PD, increasing the incidence of severe complications and mortality. To reduce the risks, individualized preoperative strategies, monitoring and prevention of POPF and PPAP in the perioperative management program of patients undergoing PD are necessary.