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An Assessment of the Time to Presentation, Clinical Features, Diagnosis, Treatment and Analysis of Risk Factors associated with the development of Abscesses, Pancreatic Fistulas and Enteric Leaks after Pancreaticoduodenectomy without Operative Drainage
*Annabelle L. Fonseca, *John W Kunstman, *Abby Hochberg, Ronald R Salem
Yale University School of Medicine, New Haven, CT

To analyze time to presentation, clinical features, methods of diagnosis and treatment of intra-abdominal abscesses, pancreatic fistulas or enteric leaks that develop after pancreaticoduodenectomy (PD) without intra-abdominal drainage, and to assess risk factors associated with the same.
Retrospective review
University tertiary referral center
Consecutive patients who had PD performed by a single surgeon since cessation of routine intra-abdominal drainage.
Main Outcome Measures:
Time to presentation, clinical features, methods of diagnosis and treatment of assessed complications. Secondary outcomes assessed were associated demographic and peri-operative risk factors.
Of 231 consecutive patients, 2 were excluded as they had intra-abdominal drains placed at the operating surgeon’s discretion. 22 patients (9.6%) developed an intra-abdominal abscess, pancreatic fistula or enteric leak (6 abscesses, 12 pancreatic fistulas, 4 enteric leaks). Presenting clinical features included fever (72.73%), abdominal pain (59.09%), delayed gastric emptying (22.73%), tachycardia (27.27%), hypotension (13.63%) and leukocytosis (81.82%). Patients presented between post-operative day (POD) 7- 40 (median POD 14). Diagnosis was by CT imaging in all but one patient where peritonitis was the presenting symptom. 18 patients were treated by Interventional Radiology drainage and 4 by laparotomy. Pancreatic adenocarcinoma was the indication for surgery in 90 patients (39.30%), however none of these patients developed pancreatic fistulas. Soft pancreatic texture (p= 0.004) and increased BMI (p= 0.001) were associated with development of abscesses, fistulas and leaks.
9.6% of patients who underwent PD without intra-abdominal drainage developed intra-abdominal abscesses, pancreatic fistulas or enteric leaks. Median time to presentation was POD 14. Fever and leukocytosis were the most common presenting clinical features. Soft pancreatic texture and increased BMI was significantly associated with development of complications.

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