Sahakyan M.A., Stepanyan S.A., Gabrielyan A.M., Petrosyan H.P., Akunts A.R., Sahakyan A.M.
Pancreatjduodebectomy is the mine curative option for patients with periampullary malignancies. Pancreatic fistula is the most common complication after pancreatoduodenectomy, leading to an increase in severe postoperative morbidity, mortality and prolonged length of hospital stay. Besides that, pancreatic fistula results in an increase in hospital costs. The prevent study aimed to analyze the perioperative outcomes in patients undergoing pancreatoduodenectomy in order to identify the specific risk factors for pancreatic fistula after surgery.
A total number of 79 patients consecutively underwent pancreatoduodenectomy for periampullary benign and malignant lesions from 2000 to 2014 in leading hospitals of Yerevan city.
In all, 21 (26,6%) patients were postoperatively diagnosed with pancreatic fistula, among of which clinically relevant pancreatic fistula (grade B and C) was developed in twelve (15,2%). Patients with and without clinically relevant pancreatic fistula were comparable in term of pre- and intraoperative characteristics, except of pancreatic duct stenting. The latter was more often in those who were eventually diagnosed with clinically relevant pancreatic fistula (33% vs. 9%, p=0,04). The rates of postoperative complications, mortality and reoperations were significantly higher in patients with clinically relevant pancreatic fistula (p=0,001, 0,01 and 0,001, respectively).
Accordingly, median length of hospital stay was also longer in this group 22 vs. 12 days (p=0,001). According to the univariate analysis, the estimated intraoperative blood loss greater than 500ml, preoperative diabetes melintus and pancreatic duct stenting during surgery had predictive value for the development clinically relevant pancreatic fistula. Multivariate regression analysis estimated intraoperative blood loss greater than 500ml as the only independent risk factor for the development of clinically relevant pancreatic fistula (OR- 5,08; 95% CI-1,17-21,98).
Surgeons experience can be one of the decisive factors affecting on the decrease of the intraoperative blood loss during pancreatoduodenectomy. Hence, it is presumed that growing experience in implementation of these procedures will let to reduce the development rate of pancreatic fistula and improve short-term results after pancreatoduodenectomy in patients with periampullary malignancies.
The New Armenian Medical Journal Vol.9(2015),No 4, p. 95-101
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