Role Of Gastric pH In Post Pancreatectomy Hemorrhage After Pancreaticogastrostomy In Whipple Procedure

Abstract

BACKGROUND: Postpancreatectomy hemorrhage (PPH) is one of the most severe complications after pancreaticoduodenectomy. METHODS:This prospective study was done in a tertiary care center to find out the role of gastric pH in postpancreatectomy hemorrhage. The gastric pH study is done by Ryle’s tube aspiration – 1) fasting ph value 1 hour before surgery and second value after 48 hrs of surgery. RESULTS: Of the total 27 patients who underwent Whipple’s procedure, 6 patients develop postpancreatectomy hemorrhage. On applying unpaired T test it was found that the difference was significant (p value <0.05) in the mean pH values among those with PPH when compared to those without PPH. The mean pH levels (mean ± Sd) among bleeders was 3.39 ± 1.80 and among non bleeder was 6.33 ± 1.03. The mean pH values were significantly lower in those where bleeding was present. The area under the curve of the ROC analysed and it was found that that the PH of 4.1 had maximum sensitivity (50%) and specificity (95.2%). Based on this, association between bleeding and PH value of 4.1 as cutoff was analysed using chi square test and it was found that the incidence of bleeding was significantly (p value <0.05) higher among those who had a PH value <4.1 (75%) compared to those with PH >4.1 (13%) CONCLUSION: Persistent low gastric pH is associated with increased risk of post pancreatectomy Hemorrhage.Suppression of the intrinsic gastric acid secretion will be helpful in reducing the risk of bleeding after Pancreaticogastrostomy in Whipple procedure.