Discussion on prevention and treatment strategies of pancreatic fistula and pancreatic fistula complicated with hemorrhage after pancreatoduodenectomy.

Objective To explore the prevention and treatment strategies for pancreatic fistula and pancreatic fistula combined with hemorrhage after pancreaticoduodenectomy. Methods We retrospectively reviewed 90 cases of pancreaticoduodenectomy at Guangdong Provincial People's Hospital from August 2019 to December 2022. According to whether postoperative pancreatic fistula occurred, the 90 patients were divided into a postoperative pancreatic fistula group (n = 35) and a postoperative non-pancreatic fistula group (n = 55). Among the 35 patients with postoperative pancreatic fistula, they were further categorized into two subgroups based on the presence of hemorrhage: the pancreatic fistula with hemorrhage group (n = 10) and the pancreatic fistula without hemorrhage group (n = 25). Chi-square test or Fisher's exact test was used for univariate analysis. Variables with statistical differences were selected for stepwise regression variable screening. Multivariate Logistic regression analysis was used to determine the independent risk factors for the occurrence of pancreatic fistula and postoperative pancreatic fistula with hemorrhage. Results All 90 patients successfully completed the pancreaticoduodenectomy. The incidence of postoperative pancreatic fistula was 38.9% (35/90). Significant differences were observed in pancreatic duct diameter (P = 0.013), intraoperative blood loss (P = 0.045), anastomosis type (P = 0.045), and residual pancreatic texture (P = 0.10) between the two groups (P < 0.05). Multivariate logistic regression analysis revealed that soft pancreas texture, pancreatic duct diameter < 3 mm, intraoperative blood loss ≥ 300 mL, and pancreatic-ojejunostomy were independent risk factors for postoperative pancreatic fistula. Among patients with postoperative pancreatic fistula, multivariate logistic regression analysis identified pancreatic fistula volume > 100 mL and duration of postoperative pancreatic fistula > 7 days as independent risk factors for hemorrhage. Conclusions The risk of pancreatic fistula after pancreatoduodenectomy is relatively high. Attention to preoperative pancreatic duct diameter and standardized evaluation of pancreatic texture can help identify postoperative pancreatic fistula. Careful hemostasis during operation and avoidance of early postoperative hemorrhage can reduce the incidence of grade B and C pancreatic fistulas. Patients with pancreatic fistula should be warned of the occurrence of combined hemorrhage when the fistula volume is greater than 100ml and the duration of postoperative pancreatic fistula is greater than 7 days. [ABSTRACT FROM AUTHOR]