Pancreaticoduodenectomy in the Setting of Pre-operative Post Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Intraoperative Challenges and Post-operative Outcome

Solanki Rashesh; Mehta Maulik; Vaishnav Dhaivat; Desai Gaurav

doi:10.7869/tg.625

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Pancreaticoduodenectomy in the Setting of Pre-operative Post Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Intraoperative Challenges and Post-operative Outcome

Solanki Rashesh¹, Mehta Maulik², Vaishnav Dhaivat³, Desai Gaurav⁴

¹Department of Gastrointestinal Surgery, Narayana Multi-speciality Hospital and GCS Medical College and Research Centre, Ahmedabad, India; ²Department of General Surgery, Civil Hospital, Ahmedabad, India; ³Department of GI Oncology, Apollo Hospitals and Gastrointestinal surgery, GCS Medical college, Ahmedabad, India; ⁴Department of Community Medicine and Biostatistics, GMERS Medical college, Gandhinagar, India.

Corresponding Author:

Dr Rashesh Solanki

Email: raseshsolanki@yahoo.co.in

Abstract

Background: Pancreaticoduodenectomy (PD) in the setting of preoperative post-ERCP acute pancreatitis (PAP) might pose significant challenges and leads to higher morbidity as compared to those without acute pancreatitis. The aim of the study was to study patients undergoing PD and compare intraoperative variables and postoperative outcomes in patients with and without preoperative PAP.

Methods: We retrospectively analysed 20 patients who underwent PD from January 2015 to July 2017. Out of these, 2 patients had preoperative PAP following endoscopic biliary drainage for cholangitis.This group was compared with the rest 18 patients (control group) in terms of patient characteristics, operative variables and postoperative outcomes. Postoperative outcomes and overall complication rate, specifically hemorrhage, delayed gastric emptying and pancreatic fistula were noted. The postoperative complications in stented (n=9) and non-stented (n=11) patients were studied. Risk factors for pancreatic fistula were analysed in entire study population. (n=20).

Results: PAP was found in 2 out of 20 patients (10%). The number of complications were higher in the PAP group (8/2) compared to control group (20/18). The ICU stay, delayed gastric emptying (DGE)and postoperative stay was higher in PAP group. There was one perioperative mortality due to grade C pancreatic fistula in the control group. Overall as well as infectious complications, were not statistically different in stented versus non-stented group. Soft pancreas(p=0.001) and non-dialted pancreatic duct (p=0.004) were significantly associated with pancreatic fistula.

Conclusion: PD in the setting of PAP is feasible, albeit associated with more frequent complications, prolonged ICU and hospital stay.