Initial Experience of Pancreaticoduodenectomy in a Newly Developed Hepato-pancreato-Biliary Unit Serving in a Lower-Middle Income Country

Abstract

Introduction: Pancreaticoduodenectomy (PD) is the only potentially curative treatment for pancreatic head adenocarcinoma. This study aimed to determine short-term outcomes of PD performed over one year at a newly established Hepato-Pancreatico-Biliary (HPB) unit in Khyber Pakhtun Khwa (KPK) Province of Pakistan. Material and methods: A retrospective analysis of a prospectively maintained Hospital Information System (HIS) was undertaken of all patients referred to the unit between May 2021 to August 2022. Data were collected from the medical records of patients in the hospital information system. Data were analyzed for primary location, age, complications, and operative parameters. Results: The primary site of disease were ampulla (n=18, 52.9%), pancreas (n=11, 32.4%), and duodenum (n=5, 14.7%). The median duration of surgery was 7 hours. 16 (47.1%) patients required blood transfusion either intraoperatively or in the peri-operative period. Patients with preoperative biliary drainage (PBD) were more likely to have multidrug-resistant positive bile cultures with a p-value of 0.2 [n=12(35.3%) vs n=5(14.7%)]. Overall morbidity was 38.2%. The most common complications were wound infection (n=12, 35.3%), delayed gastric emptying (n=6, 17.6%), and type B pancreatic fistula (n=3, 8.8%). The complication rate was higher in patients with biliary stenting [n=11(32.4%) vs n=2 (5.9%); p-value 0.06]. The median length of hospital stay for patients without complications was less (6 vs 12 days; P<.001). The complication rate was lower in Total Laparoscopic PD (TLPD) with p=0.4 (TLPD;2.9%, open; 23.5%, laparoscopic-assisted;11.8%). 90-day mortality was zero. Conclusion: Short-term outcomes for PD in our facility are comparable to high-volume centers. Preoperative biliary drainage can significantly increase operative time, hospital stay, and morbidity.

Keywords

• Pancreaticoduodenectomy
• preoperative biliary drainage
• postoperative pancreatic fistula
• total laparoscopic pancreaticoduodenectomy
• Whipple’s procedure