# RISK FACTORS FOR POSTOPERATIVE PANCREATIC FISTULA FOLLOWING PANCREATICODUODENECTOMY: TUNISIAN CENTER EXPERIENCE

## TL;DR

This study from Tunisia identifies soft pancreatic texture as the main risk factor for pancreatic fistulas after a complex surgery called pancreaticoduodenectomy.

## Contribution

The study identifies soft pancreatic texture as the only independent risk factor for postoperative pancreatic fistulas in a Tunisian surgical center.

## Key findings

- 32% of patients developed a pancreatic fistula after surgery.
- Soft pancreatic texture was the only independent risk factor for fistula formation.
- Five patients died due to complications from pancreatic fistulas.

## Abstract

Pancreaticoduodenectomy (PD) is a major intervention in digestive surgery. Although its mortality is currently low in experienced centers, morbidity remains high, dominated by a pancreatic fistula.

The aim of this study was to analyze the risk factors for postoperative pancreatic fistula (POPF) after PD.

A retrospective study was conducted at the General Surgery Department of Habib Thameur University Hospital in Tunis for 12 years (2010–2021). All patients who underwent PD were included regardless of indications.

Our series comprised 50 patients, consisting of 27 men and 23 women. The rate of a pancreatic fistula was 32% (16 patients) with an average time of onset of 5 days (1–12 days). It was observed as a biochemical leak (grade A) in 1 patient (2%), pancreatic fistula grade B in 5 patients (10%), and pancreatic fistula grade C in 10 patients (20%). Pancreatic fistula was responsible for 10% of postoperative mortality (five patients). Univariate analysis showed a statistically significant correlation between POPF and the following factors: diameter of the main pancreatic duct ≤3 mm (p=0.036, p<0.05), soft texture of the pancreas (p=0.025, p<0.05), pancreaticojejunostomy by two semi-overlapping sutures (p=0.049, p<0.05), and fasting blood glucose level ≤8 mmol/l (p=0.025, p<0.05). Multivariate analysis showed that soft pancreatic texture was the only independent risk factor for POPF (p=0.02, p<0.05).

The soft texture of the pancreas is the only independent risk factor for POPF. Prospective randomized studies are still needed to accurately determine the true risk factors for a pancreatic fistula after PD.