A study on predictive factors for anastomotic leakage in enteropancreatic anastomosis in a tertiary centre in Andhra Pradesh

Bharath Kumar Desu; Supreeth Kumar Reddy Kunnuru; Mayank Kumar Gurjar; Varun Palanati; Muni Krishna Salavakam; Rakesh R.; Gurudutt P. Varty; Praneeth Reddy Challapalli; Thirunavukkarasu S.

doi:10.18203/2349-2902.isj20194069

Authors

Bharath Kumar Desu Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Supreeth Kumar Reddy Kunnuru Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Mayank Kumar Gurjar Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Varun Palanati Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Muni Krishna Salavakam Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Rakesh R. Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Gurudutt P. Varty Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Praneeth Reddy Challapalli Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India
Thirunavukkarasu S. Department of Surgical Gastroenterology, Narayana Medical College, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20194069

Keywords:

Pancreatic fistula, Pancreaticojejunostomy, Fistula risk score

Abstract

Background: This study aimed to identify various factors influencing occurrence of post-operative pancreatic fistula.

Methods: Only those patients who underwent standard pancreatojejunostomy anastomosis in duct to mucosa technique using vicryl 4-0 sutures (double layer- interrupted fashion) were included in the study. Patients who had duct size ≤3 mm underwent papillary like main pancreatic duct invaginated technique of pancreaticojejunostomy (fish mouth type).

Results: In 40 patients, 10 patients (25%) developed postoperative pancreatic fistula. 5 (12.5%) patients had grade A pancreatic fistula and 5 patients had CR–POPF [grade B–3(7.5%), grade C–2(5%)]. Pancreatic fistula in relation with duct size has attained statistical significance. When all the four factors were put together and given fistula risk score, it correlated well with the occurrence of fistula. Fistula risk score has high negative predictive value. Of 40 patients, 13 patients fall into low risk zone, out of which 1 patient developed grade A fistula. 26 patients fall into moderate risk zone, out of which 4 patients developed grade A, 3 patients developed grade B and 1 patient developed grade C fistula. One patient fall into high risk zone and developed grade C fistula.

Conclusions: We found in our study that, post-operative pancreatic fistulae could be modestly predicted using fistula risk score. However, the latter had high negative predictive value and thus could be used to prognosticate risk of non-development of fistula than predicting its severity.

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