The Role of External Drainage and Octreotide in Preventing Complications after Pancreaticoduodenectomy

ABSTRACT

PURPOSE: A pancreatic fistula is the most dreaded complication following a pancreaticoduodenenctomy, and various methods have been used to for its prevention. This study was designed to evaluate the role of external tube drainage of the pancreatic duct, and the use of octreotide in preventing complications following a pancreaticoduodenectomy. METHODS: 137 patients (82 men, 55 women; mean age 63.3 years) diagnosed with either a periampullary cancer (115), chronic pancreatitis (13), or trauma (9) and who had undergone a pancreaticoduodenectomy (classic Whipples' operation (78), PPPD (59)) were evaluated. The patients were divided into 3 groups; Group A (n=31) with externally drained pancreatic juice, but with out the use of octreotide, Group B (n=56) with externally drained pancreatic juice, and the used of octreotide, and Group C (n=50) with the used of octreotide only with no external tube drainage. RESULTS: The morbidity and mortality were 38/137 (28%) and 2/137 (1.5%), respectively. A pancreatic fistula developed in 7 cases (5%), but no statistically significant differences were shown between the groups. The levels of serum amylase on the 1st, 3rd, 5th and 7th postoperative days were lower in groups B and C, those using octreotide (P<0.01). The level of amylase in the drain fluid were also lower in groups B and C on the 7th day (P<0.01). Group C had the lowest amylase levels in both the serum and drain fluid. CONCLUSION: The external drainage of pancreatic juice is considered to be of little significance in preventing complications following a pancreaticoduodenectomy, but the postoperative use of octreotide is helpful in preventing complications due to the prevention of postoperative pancreatic sweating.