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Afferent Loop Decompression Technique is Associated with a Reduction in Pancreatic Fistula Following Pancreaticoduodenectomy

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Abstract

Objectives

Postoperative pancreatic fistula (POPF) is a major complication and main cause of mortality after pancreaticoduodenectomy (PD). Afferent loop decompression technique (ALDT) has theoretical feasibility to reduce the rate of POPF. The aim of this study is to determine whether ALDT is a protective factor for POPF.

Methods

A total of 492 consecutive patients who underwent PD between January 2012 and December 2014 were identified from a prospective database. All data were extracted and events were judged based on medical records. Propensity score matching was conducted to balance several variables. Univariate and multivariate analyses were performed, respectively, to investigate the independent risk factors for pancreatic fistula. ALDT required a nasogastric tube with multiple side holes to be placed deep into the afferent jejunal limb. The rationale for this technique was to prevent pancreatic fistula by decreasing intraluminal pressure in the afferent jejunal loop by placement of the nasogastric tube and the application of continuous low-pressure suction after surgery.

Results

The total rate of POPF for the entire cohort was 30.7%, and ISGPS grade-A/B/C POPF rates were 18.1, 10.6 and 2.0%, respectively. In-hospital mortality was 1.6%. Among the 331 patients who received ALDT, 89 developed pancreatic leakage (26.9 vs. 38.5% for non-ALDT; P = 0.009) and eight developed biliary leakage (2.4 vs. 6.2% for non-ALDT; P = 0.035). Apart from ALDT, decreased preoperative ALT, soft pancreas, long operative time and tumour presence in the lower common bile duct (as opposed to the pancreas) were identified as other independent risk factors for POPF following multivariate logistic regression analysis.

Conclusions

ALDT may reduce the incidence of POPF after PD.

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Acknowledgements

This study was funded by the National Natural Science Foundation of China (Grant No. 81272382&81672449), the Innovation Capability Development Project of Jiangsu Province (No. BM2015004 to YM), and by the Jiangsu Province Funding Programme for Six Major Talent Summit, China (Grant No.2014-WSW-006). The authors gratefully appreciate Dr. Christopher Halloran for review of the manuscript. The approval number is 2018-SR-070.

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Author notes

  1. J. Yin and Z. P. Lu contributed equally to this work. K. R. Jiang and Y. Miao contributed equally to this article and are considered as joint corresponding authors.

Authors and Affiliations

  1. Department of General Surgery, Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China

    Jie Yin, Zipeng Lu, Pengfei Wu, Junli Wu, Wentao Gao, Jishu Wei, Feng Guo, Jianmin Chen, Kuirong Jiang & Yi Miao

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  1. Jie Yin
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Correspondence to Kuirong Jiang or Yi Miao.

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Yin, J., Lu, Z., Wu, P. et al. Afferent Loop Decompression Technique is Associated with a Reduction in Pancreatic Fistula Following Pancreaticoduodenectomy. World J Surg 42, 3726–3735 (2018). https://doi.org/10.1007/s00268-018-4679-6

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