The methods of prophylaxis of the morbidity occurrence after pancreatico-duodenal resection

Abstract

Objective. To elaborate the system of measures with objective of lowering of the occurrence rate for pancreatic fistula and severe complications after pancreaticoduodenal resection (PDR). Маterials and methods. Results of treatment was analyzed for 143 patients, to whom pancreaticoduodenal resection performed. In accordance to the scheme proposed, using elaborated scale of the risk for occurrence of postoperative pancreatic fistula, were operated 56 patients in 2017 - 2018 yrs (the main group). Comparative group consisted of 87 patients, operated in the clinic in 2015 - 2016 yrs without estimation of the risk for postoperative pancreatic fistula occurrence and sarcopenia presence, and formation of pancreaticojejunoanastomosis have depended upon decision of a surgeon-operator. Results. The rate of occurrence of the postoperative complications was trustworthily higher in the comparison group (c2 = 5.8, p=0.01). In the main group a clinically significant pancreatic fistula of Grade В was observed in 1 of 7 patients with postoperative complications. In the comparison group pancreatic fistulas of Grades В or С were diagnosed in 15 of 26 patients with postoperative complications, which are trustworthily higher, than in the main group (c2 = 4.16, p=0.04). Conclusion. The system of measures elaborated gave the possibility to reduce the occurrence rate for pancreatic fistula significantly - from 17.2 tо 1.8% and severe postoperative morbidity - from 29.9 tо 12.5%.

Keywords

• sarcopenia; pancreaticoduodenal resection; scale of the risk for the pancreatic fistula occurrence.