RISK FACTORS FOR POSTOPERATIVE PANCREATIC FISTULA FOLLOWING PANCREATICODUODENECTOMY: TUNISIAN CENTER EXPERIENCE.

Background: Pancreaticoduodenectomy (PD) is a major intervention in digestive surgery. Although its mortality is currently low in experienced centers, morbidity remains high, dominated by a pancreatic fistula.

Aims: The aim of this study was to analyze the risk factors for postoperative pancreatic fistula (POPF) after PD.

Methods: A retrospective study was conducted at the General Surgery Department of Habib Thameur University Hospital in Tunis for 12 years (2010-2021). All patients who underwent PD were included regardless of indications.

Results: Our series comprised 50 patients, consisting of 27 men and 23 women. The rate of a pancreatic fistula was 32% (16 patients) with an average time of onset of 5 days (1-12 days). It was observed as a biochemical leak (grade A) in 1 patient (2%), pancreatic fistula grade B in 5 patients (10%), and pancreatic fistula grade C in 10 patients (20%). Pancreatic fistula was responsible for 10% of postoperative mortality (five patients). Univariate analysis showed a statistically significant correlation between POPF and the following factors: diameter of the main pancreatic duct ≤3 mm (p=0.036, p<0.05), soft texture of the pancreas (p=0.025, p<0.05), pancreaticojejunostomy by two semi-overlapping sutures (p=0.049, p<0.05), and fasting blood glucose level ≤8 mmol/l (p=0.025, p<0.05). Multivariate analysis showed that soft pancreatic texture was the only independent risk factor for POPF (p=0.02, p<0.05).

Conclusion: The soft texture of the pancreas is the only independent risk factor for POPF. Prospective randomized studies are still needed to accurately determine the true risk factors for a pancreatic fistula after PD.