Received: Fri 28, Mar 2025
Accepted: Thu 08, May 2025
Abstract
Objective: This study aims to evaluate the impact of drainage tube placement at the pancreatojejunostomy site on the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) following laparoscopic pancreaticoduodenectomy (LPD).
Methods: This retrospective single-center analysis included 163 patients who underwent LPD between January 2017 and August 2023. Based on the placement of the drainage tube, patients were divided into two groups: the posterior group (n=95, with the drainage tube placed behind the anastomosis) and the superior group (n=68, with the drainage tube placed above the anastomosis). The primary outcome was the incidence of CR-POPF, and secondary outcomes included other postoperative complications such as biliary fistula and delayed gastric emptying (DGE).
Results: The incidence of CR-POPF was significantly lower in the superior group (7.4%) compared to the posterior group (25.5%) (P = 0.003). Multivariate logistic regression analysis identified soft pancreatic texture (OR = 3.506, 95% CI: 1.469-8.368, P = 0.005) and posterior drainage tube placement (OR = 3.958, 95% CI: 1.380-11.352, P = 0.011) as independent risk factors for CR-POPF.
Conclusion: This study indicates that the positioning of the drainage tube at the pancreatojejunostomy significantly affects the incidence of CR-POPF following LPD. Placing the drainage tube above the anastomosis significantly reduces the risk of CR-POPF. Optimizing drainage tube placement strategies may help reduce postoperative complications. Further prospective studies are needed to confirm the optimal drainage strategy to improve postoperative outcomes.
Keywords
Laparoscopic pancreaticoduodenectomy, pancreaticoenteric anastomosis, drainage tube placement, postoperative complications, clinically relevant postoperative pancreatic fistula
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