Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1872-1879
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1872
Application of air insufflation to prevent clinical pancreatic fistula after pancreaticoduodenectomy
Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen
Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Xiao-Fei Lu, Department of General Surgery, Jinan Central Hospital, Shandong University, Jinan 250013, Shandong Province, China
Author contributions: Yang H and Lu XF contributed equally to this article; Chen YX designed research; Chen YX, Yang H, Lu XF, Guo S and Liu Y performed research; Xu YF and Liu HD contributed analytic tools; Yang H and Lu XF analyzed data; and Yang H wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Xin Chen, Professor, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, No. 44 WenhuaXi Road, Jinan 250012, Shandong Province, China. yxs20081020@gmail.com
Telephone: +86-531-82166651 Fax: +86-531-82169243
Received: May 22, 2014
Peer-review started: May 23, 2014
First decision: June 27, 2014
Revised: July 28, 2014
Accepted: September 12, 2014
Article in press: September 16, 2014
Published online: February 14, 2015
Abstract

AIM: To introduce an air insufflation procedure and to investigate the effectiveness of air insufflation in preventing pancreatic fistula (PF).

METHODS: From March 2010 to August 2013, a total of 185 patients underwent pancreaticoduodenectomy (PD) at our institution, and 74 patients were not involved in this study for various reasons. The clinical outcomes of 111 patients were retrospectively analyzed. The air insufflation test was performed in 46 patients to investigate the efficacy of the pancreaticojejunal anastomosis during surgery, and 65 patients who did not receive the air insufflation test served as controls. Preoperative assessments and intraoperative outcomes were compared between the 2 groups. Univariate and multivariate analyses were performed to identify the risk factors for PF.

RESULTS: The two patient groups had similar baseline demographics, preoperative assessments, operative factors, pancreatic factors and pathological results. The overall mortality, morbidity, and PF rates were 1.8%, 48.6%, and 26.1%, respectively. No significant differences were observed in either morbidity or mortality between the two groups. The rate of clinical PF (grade B and grade C PF) was significantly lower in the air insufflation test group, compared with the non-air insufflation test group (6.5% vs 23.1%, P = 0.02). Univariate analysis identified the following parameters as risk factors related to clinical PF: estimated blood loss; pancreatic duct diameter ≤ 3 mm; invagination anastomosis technique; and not undergoing air insufflation test. By further analyzing these variables with multivariate logistic regression, estimated blood loss, pancreatic duct diameter ≤ 3 mm and not undergoing air insufflation test were demonstrated to be independent risk factors.

CONCLUSION: Performing an air insufflation test could significantly reduce the occurrence of clinical PF after PD. Not performing an air insufflation test was an independent risk factor for clinical PF.

Keywords: Pancreatic fistula, Pancreaticoduodenectomy, Air insufflation test, Surgery, Morbidity

Core tip: The present study introduces the application of the air insufflation test for the prevention of pancreatic fistula (PF) and investigates its effectiveness. This clinical study confirms that the air insufflation test can significantly reduce the occurrence of clinical PF. In addition, estimated blood loss, pancreatic duct diameter ≤ 3 mm and not performing an air insufflation test are independent risk factors for clinical PF.