Risk Factors for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy National Liver Institute Experience

Aim: To assess pancreatic fistula risk factors following pancreaticoduodenectomy.Methods: This was a retrospective study that included 310 consecutive cases of pancreaticoduodenectomy carried outat the National Liver institute, Menoufia University, conducted from January 1, 2015, to December 31, 2023.Results: Following pancreaticoduodenectomy, 90 (29.0%) patients of pancreatic fistula developed, comprising 18(16.2%) grade A cases, 59 (53.1%) grade B cases, and 13 (11.7%) grade C cases. Age, hypertension, management ofpreoperative jaundice, preoperative levels of albumin and bilirubin, drainage of the duct of pancreas, smoking, previousupper abdominal surgery, intraoperative loss of blood and time, transfusion of blood intraoperatively (anastomosis ofBraun), and pancreaticoduodenectomy were not demonstrated to be significantly correlated with POPF in the univariateanalysis. Conversely, the other variables significantly correlated with POPF were diabetes (non-diabetic vs. diabetic:38.9% vs. 61.1%, P = 0.010), gender (male vs. female: 55.6% vs. 44.4%, P = 0.671), Body mass index (BMI) (≤ 25 vs> 25: 44.4% vs 55.6%, P = 0.301), technique of panareaticojejunal anastomosis (pancreatic duct-jejunum double-layermucosa-to-mucosa pancreaticojejunal anastomosis vs pancreatic-jejunum single-layer mucosa-to-mucosa anastomosis:40.0%, vs. 55.6% P = 0.019), the pancreatic duct diameter (≤ 3 mm vs > 3 mm: 53.3% vs 46.7%, P = 0.014), and textureof pancreas (soft vs hard: 54.4% vs 45.6%, P = 0.036). Female gender, BMI greater than 25, diabetic status, and pancreaticduct diameters ≤ 3 mm were risk factors for pancreatic fistula after pancreaticoduodenectomy.Conclusion: Male gender, BMI more than 25, diabetes, a 3 mm or less diameter of pancreatic duct, soft pancreas,and double layer of mucosa to mucosa pancreaticojejunal anastomosis, , were specific factors that enhanced the possibility of pancreatic fistula after pancreaticoduodenectomy.Core tip: Our present study included 310 cases in order to elucidate the causative risk factors contributing to itsdevelopment. The multivariate analysis is confirmed to be able to associate the development of the pancreatic fistula withmale patients, patients whose BMI greater than 25, Diabetic patients, double-layer Mucosa-Mucosa pancreatojejunostomy.