Evaluation of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy

Background: Pancreatic fistula (PF) remains the most common and challenging complication following pancreaticoduodenectomy (PD), with an incidence of 2%–28%. The primary objective of this study was to assess the correlation of fatty infiltration and fibrosis of the pancreas with postoperative pancreatic fistula (POPF). Secondary objectives were to investigate the correlations of POPF with the main pancreatic duct size and subjective intraoperative assessment of pancreatic texture and to determine if diabetes mellitus (DM), body mass index, or increased serum bilirubin correlate with POPF. Materials and Methods: This prospective study was performed at Sudhamayi Hospital, Kochi, India. Forty-six patients were included and divided into either the fatty infiltration group ( n = 20) or fibrosis group ( n = 17); nine patients had neither fatty nor fibrotic glands. Data were analyzed using analysis of variance and Chi-square test, utilizing SPSS software version 20 (IBM Inc., Armonk, NY, USA). Results: Patients with fatty pancreas had a ten times higher incidence of PF than those with fibrotic pancreas (odds ratio, 10.8; 95% confidence interval [CI], 2.2–52.4; P = 0.003). POPF was 7.9 times higher in patients with a nondilated duct compared to patients with a dilated duct (95% CI, 2.118–29.5; P = 0.003). Preoperative elevated serum bilirubin, body mass index, and DM were not found to be significant risk factors for POPF. Conclusion: We demonstrated that fatty pancreas and small pancreatic duct size (≤3 mm) are risk factors for POPF. Preoperative elevated serum bilirubin, body mass index, and DM were not found to be significant risk factors.