External pancreatic duct drainage in pancreaticojejunostomy following pancreaticoduodenectomy

Background: Pancreaticoduodenectomy (PD) remains the standard treatment for pancreatic head tumors, but postoperative pancreatic fistula is common, especially with soft pancreas. External drainage may reduce pressure and improve healing. Aim: To evaluate the impact of external pancreatic duct drainage (EPDD) after pancreaticojejunostomy on clinical outcomes in patients with soft pancreas indicated for pancreaticoduodenectomy mainly incidence of POPF and its grades (A, B or C). Patients and methods: This Prospective study was conducted at Minia liver and GIT Hospital, Egypt, including (20) patients indicated for pancreaticoduodenectomy in the period between August 2024 and April 2025 and all cases were assessed intraoperatively and only soft pancreas is included in the study. Results: Postoperative complications included pancreatic fistula, post-pancreatectomy hemorrhage, and upper gastrointestinal bleeding (5% each), surgical site infection (25%), delayed gastric emptying (0%), pancreatitis (15%), and pulmonary issues (5%). Reoperation and 30-day mortality were 5%. No biliary leaks or abscesses were reported. Pathology showed ductal adenocarcinoma (40%), ampullary carcinoma (40%), cholangiocarcinoma and duodenal carcinoma (10% each). Oral intake resumed by day 1.7, flatulence by day 1.9, and hospital stay averaged 7.25 days. Stents were removed after 28-42 days (median output 150 mL/day), and drains after 6 days (300 mL). Stent-related issues occurred in 30%: 10% occlusion, 5% migration, and 15% malfunction, increasing the risk of pancreatic fistula. Conclusion: This study assessed outcomes of pancreaticoduodenectomy with external stented pancreaticojejunostomy in patients with a soft pancreas.Most patients were middle aged males with peri ampullary cancers.