Pancreatic Fistula and Other Post-Operative Complications of InternalVersus External Pancreatic Duct stent in Patients withPancreaticoduodenectomy

Abstract

Introduction: Pancreaticoduodenectomy (PD) is a complex surgery for pancreatic cancers, often complicated by pancreatic fistula (PF). This study compares outcomes of internal versus external pancreatic duct stents in PD. Methods & Materials: This prospective observational study was conducted at Dhaka Medical College Hospital from January 1, 2023, to December 27, 2023. A total of 40 patients who underwent PD were included, with 20 patients managed using internal pancreatic duct stents and 20 using external stents. Data on demographic characteristics, surgical details, and postoperative outcomes were collected and analyzed. The primary endpoints were the incidence of pancreatic fistula, delayed gastric emptying, intra-abdominal abscess, and overall morbidity. Results: The study found that the internal stent group had a lower incidence of pancreatic fistula, with 10% developing grade A PF and no occurrences of grade B or C PF. In contrast, the external stent group had higher incidences, with 15% developing grade A, 10% grade B, and 5% grade C PF. Postoperative complications were more frequent in the external stent group, including wound infections (15%), intra-abdominal collections (10%), gastrointestinal bleeding (5%), and intra-abdominal bleeding (10%). Operative times and net blood loss were slightly better in the internal stent group. Conclusion: Internal pancreatic duct stents are associated with fewer postoperative complications and lower incidences of severe pancreatic fistula compared to external stents in patients undergoing pancreaticoduodenectomy. These findings suggest that internal stents may be a safer and more effective option for managing pancreatic anastomosis during PD.