Assessing the Role of Pancreatic Duct and Consistency in Forecasting Post-Pancraticodoudenectomy Pancreatic Fistula; A prospective Study

Background and Aim: Postoperative pancreatic fistula (POPF) is one of the serious complications that can happen after
pancreatic surgery, especially pancreaticoduodenectomy. The morbidity after pancreatic resection was mainly caused by
POPF. Clinical prediction patterns have been proposed with the anticipation of detecting patients who have high risk of
POPF. Persistent abdominal pain, vomiting, and postoperative secondary hemorrhage might suggest the occurrence of
POPF. The current study aimed to detect possible risk factors for POPF involved size of pancreatic duct, consistency of
the pancreas (soft or firm), intraoperative blood loss, etc.
Methods: In our study we prospectively analyzed the factors which are associated with postoperative pancreatic fistula
formation following pancreaticoduodenectomy. This research was accomplished at the General Surgery Department in
Assiut University Hospitals and Al-Rajhi Liver Hospital from March 2023 till March 2024. A total of 62 patients were
scheduled for pancreaticoduodenectomy were enrolled.
Results: The patients had a mean age of 54.40±12.82 years. The utmost frequent diagnosis in the studied patients was
pancreatic cancer (59.7%). A wound infection was reported in 15(24.2%) patients. Length of stay was <7 and >7 days in
34(54.8%) and 28(45.2%) patients, respectively. POPF occurred in 16(25.8%) patients. patients with POPF had significantly
higher mean age (60.34±5.67 vs. 44.66±8.90 (years), mean body mass index (19.45±2.22 vs. 23.03±2.89(kg/m2) and
lower albumin (32.09±2.19 vs. 39.44±4.21(mg/dl). Also, majority of patients with POPF had soft pancreatic consistency
(68.8%) and small pancreatic duct (68.8%). Predictors of POPF were low albumin, soft pancreatic consistency and small
pancreatic duct. Soft pancreatic consistency had 84.5% accuracy for prediction POPF. Meanwhile, small pancreatic duct
had 81.2% accuracy. Also, low albumin had 63% sensitivity, 67% specificity and 66% accuracy for prediction POPF
Conclusion: Patients with soft pancreatic consistency with small pancreatic duct are more liable to POPF. Strict follow
of those risky patients after pancreatoduodenectomy is highly recommended. Future work, including a larger number of
patients, is assured to verify such results.