Abstract
Purpose: Postoperative pancreatic fistula (POPF) poses a challenge to oral intake after Pancreaticoduodenectomy (PD). Various strategies such as enteral feeding via nasojejunal tube, feeding jejunostomy (FJ), and total parenteral nutrition , are employed to enhance postoperative nutrition. The routine adoption of FJ in PD remains a debatable topic. This study aims to assess and compare the efficacy of enteral feeding and parenteral nutrition in the management of POPF.
Material and methods: Seventy patients who underwent classical PD at a tertiary care center in east India between July 2019 and December 2023 were randomly allocated to FJ and non-FJ in 1:1 ratio. The primary end point was procedure related complications (POPF, delayed gastric emptying, post pancreatectomy hemorrhage , bile leak, Clavien Dindo grade ³3), length of hospital stay,additional costs, 30-day mortality and tube-related complications.
Results: Out of 70 patients who underwent PD 35 received FJ as part of the standard care while the remaining 35 patients with no FJ. The majority of POPF cases were Grade B (40 vs 31.4%). Patients with Grade B POPF who underwent routine FJ placement exhibited shorter fistula durations (3.9 vs. 5.2 weeks, p< 0.001) and reduced intraabdominal drain durations (26.4 vs. 34.9 days, p<0.001). No differences were observed in the incidence of complications , reoperation, length of hospital stay readmission and 30-day mortality. No adverse complications were associated with FJ placement.
Conclusion: For PD patients requiring prolonged postoperative nutritional support due to POPF and DGE, routine FJ can be a safe and cost-effective approach.