Pancreatic Fibrosis and Its Relation With Post Pancreaticoduodenectomy Pancreatic Fistula

Indian Journal of Applied Basic Medical Sciences
Year: 2020, Volume: 22(A), Issue. (1)
First page: (346) Last page: (352)
Online ISSN: 2249-7935
Print ISSN: 0975-8917
doi:10.48165/ijabms.2020.22134

Pancreatic Fibrosis and Its Relation With Post Pancreaticoduodenectomy  Pancreatic Fistula
Premal R. Desai 1*, Hasmukh B.Vora1 , Minesh Gandhi2 , Saumil Merchant 3, Kalpesh Shah 4,  Mahendra S. Bhavsar5
1Department of Surgical Gastroenterology, NHLM Medical College, Ahmedabad, India. 2. Dept. Of  Pathology, NHLM Medical College. 3.Ph.D. Scholar- Gujarat University, Dept. of Forensic Medicene,  AMC MET Medical College, 4. Ph.D. Guide-Gujarat University, Professor and Head, BJMC Ahmedabad.  Corresponding author email id: premalrdesai@yahoo.com

Online Published on 02-Jan-2020

ABSTRACT

Background: Pancreaticoduodenectomy (Whipple’s Procedure and its variants) is the treatment of  choice for malignant diseases of periampullary region. Postoperative Pancreatic Fistula (POPF) is the  most dreaded complication and contributes substantially to the failure rate. Data regarding the  relation of pancreatic fibrosis to pancreatic fistula is limited in the literature. Methods: Patients undergoing Pancreaticoduodenectomy (PD) for malignant etiology were included  in the study. POPF was graded according to the International Study Group of Pancreatic Surgery  (ISGPS) grading system into 3 Grades (A- mild, B- moderate, C -severe). Pancreatic Fibrosis Scale was  used for Classification of pancreatic fibrosis into three types.  Results: During the study period 48 patients of periampullary malignancy treated by PD at NHLM  Medical College, VS Hospital, Ahmedabad where enrolled. The factors which were significantly  associated with POPF in our study were Pancreatic duct size, Pancreatic Fibrosis, Age, DM, low albumin  level and intraoperative blood loss. Type 1 fibrosis was found in 14 patients out of which Grade A  fistula was found in 3 patients, Grade B fistula in 5 patients and Grade C fistula in 3 patients. Type 2  fibrosis was found in 17 patients of which Grade A fistula was found in 8 patients, Grade B fistula in 1  patient and none of Type 2 fibrosis developed Grade C fistula. Type 3 fibrosis was found in 17 patients  out of which only 2 patient developed Grade A fistula and no patient developed grade B or C fistula  with clinical relevance. High Grade of pancreatic fibrosis was associated with lower risk of POPF (0.005)  compared to Low Grade fibrosis (p value 0.0002)  Conclusion: Pancreatic fibrosis correlates well with POPF. The pathological findings of High Grade  pancreatic fibrosis has protective effect and is related to the lower rate of pancreatic fistula as  compared to Low Grade pancreatic fibrosis.

Keywords

Pancreaticoduodenectomy, Pancreatic fistula (POPF), Pancreatic