Risk factors for postoperative pancreatic fistula following, non-traumatic pancreatic surgery. Retrospective observational study

Pancreatic surgery e pancreatic fistula (POPF) is a potentially fatal sequela with substantial morbidity and mortality. POPF incidence and risk factors vary. This study aimed to evaluate the incidence and risk factors of patients with pancreatic fistula (PF) from patients undergoing various pancreatic surgeries for different pancreatic diseases. MATERIAL ANDMETHODS: A retrospective observational study was conducted in the surgical unit of our university hospitals from July 2014 to July 2019. Three hundred forty-seven patients were admitted witha clinical diagnosis of pancreatic fistula following both open and laparoscopic approaches for pancreatic benign and malignant tumors. RESULTS: The most prevalent age was >60 years (67%), with a male predominance (83%). The most common diagnosis before surgery was pancreatic head adenocarcinoma (32%), followed by duodenalneoplasm (19%) and true epithelial pancreatic cystic neoplasms (18%), ampullary neoplasms (15%), bile duct neoplasms (12%), neuroendocrine neoplasms (2%), and chronic pancreatitis (2%). The most prevalent site of the pancreatic tumor was the head (87%),while accompanied Jaundice (47%) and epigastric discomfort (37%) were the commonest presentations before surgery. Pancreatic duct diameter greater than 3 mm was present in 208 patients (60%), tumor size greater than 3 cm in63%, hard pancreatic texture in 67%, and preoperative ERCP with a stent in 37% of cases. Tumor in the tail of the pancreas was found in 5% (17 patients) of cases. The commonest operations performed were open pylorus-preserving pancreaticoduodenectomy, open pancreaticoduodenectomy without pylorus-preserving, and open distal pancreatectomy with splenic preservation. Postoperative pancreatic fistula occurred in 8% of cases (27), with ISPGF grade A (biochemicalleak) occurring in 17 patients (17/27) and clinically significant POPF occurring in 10 patients (10/27). POPF occurredin 13 patients after distal pancreatectomy, 11 patients after pancreaticoduodenectomy, two cases followed central pan-createctomy, and one. Grade B after pancreaticoduodenectomy and two after distal pancreatectomy. Grade C POPFoccurred in four patients after pancreaticoduodenectomy but not after distal pancreatectomy. Age >55 (p=0.00), male(p=0.03), presence of symptom (p=0.0008), location at Head of the pancreas (p=0.0004), elevated CA19-9 (p=0.0004),jaundice (p=0.0001) and pancreatic texture (p=0.00**). CONCLUSION: Pancreatic fistula occurred in 27 patients (8%), a comparatively low incidence. POPF was linked to age, Jaundice, gender, pancreatic head cancer, symptoms, high CA 19-9, jaundice, and a soft pancreas. POPF incidence washigher after distal pancreatectomy, whereas POPF severity was higher after pancreaticoduodenectomy