Post-Operative Complications and Their Management After Pancreaticoduodenectomy: A Single Centre Experience

Abstract

Objectives: To evaluate post-operative complications and their management after Pancreaticoduodenectomy (PD) at Surgical Gastroenterology department at Government Medical College Hospital in North India. Materials and Methods: Retrospective analysis of database of Pancreaticoduodnectomy patients was done. Main demographic variables, indications of surgery and early postoperative complications and their management were evaluated. Statistical analysis was done with the help of Microsoft excel software.Results: A total of 176 Patients underwent PD from January 2013 to December 2018. 162 patients underwent open PD and 14 underwent laparoscopic/ laparoscopic assisted PD. 128 operations were done for periampullay carcinoma, 16 for carcinoma head of pancreas, 7 for neuroendocrine tumor, 7 for cystic tumor of pancreas, 4 for duodenal carcinoma, 3 for cholangiocarcinoma, 2 for GIST, 1 for carcinoma stomach, 2 for carcinoma Gallbladder with ampullary carcinoma (dual malignancy) and 2 for tubercular CBD stricture and 4 for chronic pancreatitis. Overall mortality was 4.5% (8 patients). Most common morbidity was surgical site infection (21%). Post-operative pancreatic fistula (POPF) rate was 16% (28 pt.), of which 21 patients has type A POPF, 5 patients has type B POPF and 2 patient has type C POPF. Incidence of DGE and post-operative bleed was 14.7% and 3.4% respectively.Conclusion: With adequate surgical expertise, improved perioperative care and multispecialty approach, pancreaticoduodenectomy now can be performed with low morbidity and mortality in present era of surgical advancement and nihilistic view regarding this surgery prevalent in some developing countries should be abandoned. Internal stenting may be useful in decreasing POPF rates, all measures should be taken to control preoperative cholangitis to decrease postoperative sepsis and mortality and levosulpiride may be helpful in early recovery of bowel function and oral intake.