Risk factors of pancreatic fistulas after Whipple procedure.

Abstract

Background: The Whipple procedure is a major abdominal operation because of the size of the sample and the complex anatomy, and the health situation of the patient. The procedure is associated with a high rate of morbidity due primarily to pancreatic fistula. The study aims to determine the risk factors of forming this fistula according to the classification of the ISGPF 2016.

Methods: The study included 170 patients who underwent Whipple procedure at the Al-Mouasat and Al-Assad University hospitals in Damascus between 2012 and 2018. The factors that were examined are age, sex of the patient, previous arterial hypertension, alcohol, diabetes, jaundice, albumin level, smoking, BMI, previous abdominal surgery, Preoperative (PTD or ERCP), process time, pancreatic tissue, pancreatic canal diameter, amount of surgical hemorrhage, type of anastomosis used PJ or PG and pancreatic catheterization with STENT.

Results: 85 patients had pancreatic fistula with the percentage of (50%) of the cases. 41 patients were non-clinical fistula (48.2%), 44 patients were clinical fistula (51.8%), and 36 patients (class B) and 8 (class c). Statistical analysis showed that there was a statistically significant difference in the pancreatico-jejunal anastomosis (P = 0.001) , the diameter of the pancreatic duct was less than 3 mm (P = 0.015), BMI was greater than 25 (P = 0.00), soft pancreas (P = 0.001), and these factors are risk factors for pancreatic fistula.

Conclusion: BMI, soft pancreas, small pancreatic ducts less than 3 mm, and pancreatico-jejunal anastomosis are risk factors for pancreatic fistula.

 Keywords: Pancreas, whipple, fistula, risk factors.