Rate of pancreatic fistula laparoscopic versus open Whipple Comparative study-1

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Fazl e Akbar
Muhammad Nadeem
Shah Abbas
Inayatullah Khan
Farooq Khan
Waqas Ahmad


Pancreatic fistula, Open vs, laparoscopic


This study was carried out to explore the Rate of pancreatic fistula laparoscopic versus open Whipple.

Materials and Methods: A retrospective study was carried out on 70 patients who had pancreaticoduodenectomy at Saidu Teaching Hospital, Swat - Pakistan between July 2020 and June 2021 after taking approval from the ethical committee of the institute. All individuals' demographic and perioperative information was gathered, including information on their preoperative health, the need for surgery, their history of jaundice and the nature of the procedure. SAS statistical Software (version 9.1) was used for analysis.

Results: A total of 70 patients who had done pancreaticoduodenectomy. The patients were divided into two groups. Laparoscopic pancreaticoduodenectomy (LP) N=35 and open pancreaticoduodenectomy (OP) N=35.Out of them male were n=40 (57.1%) and female were n=30(42.85). Between the two groups there was no statistical deference in ASA class, BMI, sex, age and abdominal surgery.  In both groups pancreatic fistula were observed. LP group had grade A n=2(5.7%) pancreatic fistula (PF) While the frequency of grade B and C PF was absent in LP group. The prevalence of (PF) was maximum in the OP group. Over all 11.4% of patients had PF. Out of which 50% had Grade A, 25% had Grade B and 25% C pancreatic fistula

Conclusion; the rate of pancreatic fistula is more prevalent in OP as compare to LP. So LP is better option as compared to OP for the pancreaticoduodenectomy.

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1. Kawai M, Hirono S, Okada K, Sho M, Nakajima Y, Eguchi H, 1. et al. Randomised controlled trial of pancreaticojejunostomy versusstapler closure of the pancreatic stump during distal pancreatectomy to reduce pancreatic fistula. Ann Surg 2016; 264(1):180-7.
2. kano K, Hirao T, Unno M, Fujii T, Yoshitomi H, Suzuki S,et 2. al. Postoperative infectious complications after pancreatic resection. Br J Surg2015; 102(12):1551-60
3. Peng YP, Zhu XL, Yin LD, Zhu Y, Wei JS, Wu JL, et al. Risk 3. Factors of postoperative pancreatic fistula in patients after distal pancreatectomy: A systematic review and metaanalysis. Sci Rep 2017; 7(1):185.
4. Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, et al. 4. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg 2015; 102(1):4-15.
5. Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, 5. Butturini G, et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): Arandomised, controlled multicentre trial. Lancet (London, England) 2011; 377(9776):1514-22.
6. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg. 2014; 260:633–8
7. Berger AC, Howard TJ, Kennedy EP, Sauter PK, Bower-Cherry M, Dutkevitch S, et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg. 2009;208:738–47
8. Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA et al. Metaanalysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 2014; 20:17626-17634
9. Bracale U, Pignata G, Lirici MM, Cristiano GS Hüscheet, Raffaele Pugliese,Giovanni Sgroi et al. Laparoscopic gastrectomies for cancer: The ACOI-IHTSC national guidelines. Minim Invasive Ther Allied Technol 2012; 21:313-319.
10.Horacio J Asbun, FACS, John A Stauffer. Laparoscopic vs Open Pancreaticoduodenectomy: Overall Outcomes and Severity of Complications Using the Accordion Severity Grading System, J Am Coll Surg 2012; 6: 810-819.
11.Conrad C, Basso V, Passot G, Zorzi D, Li L, Chen HC, et al. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. Surg Endosc. 2017; 31:3970–8.
12.Marcus SG, Cohen H, Ranson JHC. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Annals of Surgery 1995; 221(6): 635-648 30.)Suzuki Y, Fujino Y,Taniok
13.Suzuki Y, Fujino Y,Tanioka Y, Hiraoka K, Takada M, Ajiki T et al. Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size. Archives of Surgery 2002; 137(9): 1044-1048.

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