Internal stenting across the pancreaticojejunostomy and main pancreatic duct after pancreaticoduodenectomy

Abstract

<b> Background: </b>Postoperative pancreatic fistula (POPF) is associated with high morbidity and mortality rates. Studies have reported internal stenting of the pancreaticojejunostomy (PJ) to reduce POPF, but it is still controversial. <p> <b> Aim: </b>In this study, we compared the outcome of internal stenting across the PJ to reduce POPF following pancreaticoduodenectomy (PD) and described our technique of putting the internal stent across the PJ and in to the main pancreatic duct. <p> <b> Materials and methods: </b>Fifty patients undergoing elective PD were included. Patients were divided into two groups in a randomized fashion; Group A (n = 25) without internal stenting across the PJ and Group B (n = 25) with internal stenting of the PJ. The primary endpoint was the occurrence of POPF. <p> <b> Results: </b>Both groups were comparable in demographics, comorbidities, pathologies, pancreatic texture and pancreatic duct diameter. Out of 50 patients studied, a total of 23 (46.0%) patients developed postoperative pancreatic fistula. Ten (40%) in group A and 13 (52%) in group B (p = 0.156). Sixteen patients (32%) developed Grade A and 7 (14%) patients had Grade B postoperative pancreatic fistula. In group A, 6 patients developed grade A and 4 patients developed grade B postoperative pancreatic fistula. In group B, 10 patients developed grade A and 3 patients developed grade B postoperative pancreatic fistula. There was no Grade C fistula. All patients had satisfactory recovery after conservative management. Eight patients (16%) developed delayed gastric emptying [5 in group A and 3 in group B; p = 0.366]. Six patients developed a superficial surgical site infection (2 in group A and 4 in group B; p = 0.445). The length of hospital stay was comparable between the two groups. There was no mortality. <p> <b> Conclusion: </b> Internal stenting of PJ does not decrease the rate of POPF after PD.