Wirsung diameter and microchannel presence as risk factors in postoperative pancreatic fistulas

Abstract

Abstract Background Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is one of the most severe morbidities, which can occasionally be fatal. This study evaluated the association of the main pancreatic duct diameter and the presence of open pancreatic interlobular ducts (microchannels) of the pancreas with pancreatic fistula in the pancreaticojejunostomy anastomotic line. Methods An evaluation was made on pancreatojejunostomy anastomoses of 49 patients who underwent pyloric-preserving PD between March 2018 and October 2019 using the International Study Group of Pancreatic Fistula classification. Demographic, clinical, intraoperative, and pathological characteristics of patients without postoperative fistula and with grade A fistula (biochemical leak) were recorded. The groups were analyzed for the diameter of the duct of Wirsung and the presence of microchannels on the cross-sectional surface of the pancreatic surgical margin through the PD materials. Results Drain fluid amylase levels were more than three times higher than blood amylase levels in 32(65.3%) patients. The diameter of the duct of Wirsung in overall patients was 2.97±1.84cm. Patients with a small main pancreatic duct diameter(<3 mm) had a high risk of a biochemical leak(RR:2.38;95% CI:1.14–4.97; p:0.002). Microchannels were detected in 27(55.1%) patients. The risk of a leak was 2.45 times higher in patients with microchannels on the pancreatic cross-sectional surface (RR:0.409;95% CI:0.23–0.72;p:0.001). Conclusion A main pancreatic duct diameter of < 3 mm, and the presence of microchannels on the pancreatic cross-sectional surface may increase the risk of fistula in postoperative pancreaticojejunostomy anastomosis. Thus, it should be considered in the management of patients at risk after pancreaticoduodenectomy.