Surgeon performed interventional radiology: A necessity for establishing a HPB service in a developing country

Abstract

pancreaticoduodenctomy(PD) and distal pancreatectomy(DP). We aimed to investigate the difference of fistula rates after pancreatectomies between the different techniques Methods: We collected the datas of 500 patients that were operated between 2009e2014 at Ege University. Duct to mucosa pancreaticojejunostomy(PJ) anastomosis was performed after all PDs. The pancreatic parenchyma stump closure was achieved either with a stappler or hand sewn. Fistula was defined according to the definition of International Study Group on Pancreatic Fistula (ISGPF) (Grade A,B,C). Fisher exact test was used to determine the difference of the fistula rates between the stappled and hand sewn distal pancreatectomies. Chi-square test was used for determining the difference between the presence of the stent in the fistula rates after pancreaticoduodenectomies. Results: 247 of the patients were male and 253 of them were female with the average age of 60,3 years. Of the 500 patients, 311 were performed PD, 153 were performed DP, 32 were performed enucleation and 4 were performed duodenum preserved total pancreatectomy. Stent was used in 68 of the 311 PD's. Pancreatic parenchyma stump closure was achieved by using stappler in 7 of the 153 DP's. Fistula was determined in 14 of 68 patients that stent was placed in PJ where in 9 of 243 that stent was not used in PJ (p < 0,01). Fistula was determined in 4 of 7 patients whose stump closure was achieved by using stappler where 6 of 146 patients with hand sewn stump after DP (p < 0,01). Conclusions: We determined that using intraductal pancreatic stent while performig PJ anastomosis raises POPF rate. Hand sewn closure of pancreatic stump after DP has lower rates of POPF than stapled closure of the parenchyma.