Pancreaticoduodenectomy with Pancreaticogastrostomy and an External Pancreatic Stent in Risky Patients without Clinically Relevant PostoperativePancreatic Fistula: A Propensity Score-Matched Analysis

Abstract Background There is a continuing argument on the most suitable method for reconstructing the pancreas after pancreaticoduodenectomy (PD). This research evaluated the impact of pancreaticogastrostomy (PG) with an external pancreatic stent on the postoperative outcomes after PD in risky patients. Patients and methods: This is a propensity score-matched analysis for risky patients who underwent PD with PG reconstruction. The postoperative pancreatic fistula (POPF) was the main outcome measure. The operative time, intraoperative blood loss, hospital time, re-exploration rate, and postoperative morbidity and mortality were among the secondary outcomes. Results Seventy-eight patients were included in the study; 26 patients underwent PD with PG and an external pancreatic stent while 52 patients underwent PG without pancreatic stent. There was no significant difference between both groups as regards blood loss and operative time. The overall postoperative morbidity was higher in the non-stented group than in the stented group (34.6% vs. 15.4%, P = 0.06). In the pancreatic stent group, no patient developed clinically relevant POPF while in non-stented PG 17.3% of patients developed POPF. No hospital mortality in the stented group while in the non-stented group, two hospital mortality happened (one case due to SIRS secondary to POPF grade C and the other case due to pulmonary embolism). Conclusion Pancreaticogastrostomy with an external pancreatic stent achieves zero clinically relevant pancreatic fistula, fewer postoperative morbidities, and no mortality rate in risky patients.