OUTCOME OF OPEN DISTAL PANCREATECTOMY: AN AUDIT AT TERTIARY CARE HOSPITAL


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Amyna Jiwani1,Tabish Chawla1
1Aga Khan University Hospital

Abstract

Method

From January 2004 till December 2015, peri-operative and post operative data of 38 patients underwent distal pancreatectomy were recorded by using ICD 9 coding. Data was collected on designed performa for all patients for pancreatic/peripancreatic diseases. Quantitative variables like age, operative time, ASA level, intra-operative blood loss and postoperative hospital stay are presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor for morbidity and the development of a pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 will be considered significant.

Results

There was an increase in the rate of operations in patients with benign or malignant diseases of pancreas and a significant change in operative techniques ranging from suture technique to staples and then both. Post operative pancreatic fistula was the most common peri-operative morbidity. Associated factor for pancreatic fistula was multivisceral resection as compared to spleen preserving distal pancreatectomy and distal pancreatectomy (p-value: 0.039). While age, ASA level, BMI and blood transfusion were not statistically significant. However, the technique of stump closure when opted for suture technique was seen to be associated with higher occurrence of POPF. The mortality rate was 2.6%. Out of 8 patients with POPF, 7 were type A and B and managed conservatively however; one was type C and managed with endoscopy and surgical drainage.

Conclusion

Post operative pancreatic fistula is the most common complication seen after distal pancreatectomy as compared to other morbidity. The combination of stapler and suture closure shows superiority over suture closure alone. Prospective studies are needed for further establishment of this relationship