Perioperative outcomes of pancreaticoduodenectomy: Nepalese experience.
BACKGROUND
Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital.


METHODS
A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demographics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed.


RESULTS
Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place.


CONCLUSIONS
Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uniform definition of complications, use of a multidisciplinary approach, and identification of associated risk factors.
Lakhey
Paleswan Joshi
PJ
Department of Surgery, Tribhuwan University Teaching Hospital, GPO Box No 3578, Maharajgunj, Kathmandu, Nepal. lakheypj@gmail.com
Bhandari
Ramesh Singh
RS
Ghimire
Bikal
B
Khakurel
Mahesh
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003906:Developing Countries; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010185:Pancreatic Fistula / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome