Strategies to prevent pancreatic fistula after pancreaticoduodenectomy

Background/Aims: We evaluated the prevention of pancreatic fistula after pancreaticoduodenectomy in a retrospective clinical study. Methodology: Eighty patients undergoing pancreaticoduodenectomy between April 2007 and August 2011 were recruited. In all patients, the pancreas was reconstructed first, followed by reconstruction of the hepatic duct and the duodenum or stomach. Results: Pancreatic fistulae were observed in 21 of 80 patients (26.3%; Grade A/B/C: 9/12/0). The incidence of pancreatic fistula in patients with soft pancreas was higher than that in patients with hard pancreas (p<0.01). We investigated 54 patients with soft pancreas and pancreatic fistulae were diagnosed in 19 patients (35.2%; Grade A/B/C: 8/11/0). We evaluated pancreatic drainage methods (internal stent/external stent: 20/34) and in patients with soft pancreata, pancreatic fistulae were observed in 11 patients (55%) with internal stents vs. eight patients (23.5%) with external stents (p<0.05). Conclusions: We evaluated the management of pancreatic drainage methods and external stents were associated with a significantly lower incidence of pancreatic fistula compared with internal stents. We expect that external drainage of soft pancreas will decrease pancreatic juice leakage into the abdominal cavity. Many randomised control trials on pancreatic drainage have been reported recently; we plan to study them.