title: Application of air insufflation to prevent clinical pancreatic fistula after pancreaticoduodenectomy.
abstract: OBJECTIVE
  To introduce an air insufflation procedure and to investigate the effectiveness of air insufflation in preventing pancreatic fistula (PF).
  
  
  METHODS
  From March 2010 to August 2013, a total of 185 patients underwent pancreaticoduodenectomy (PD) at our institution, and 74 patients were not involved in this study for various reasons. The clinical outcomes of 111 patients were retrospectively analyzed. The air insufflation test was performed in 46 patients to investigate the efficacy of the pancreaticojejunal anastomosis during surgery, and 65 patients who did not receive the air insufflation test served as controls. Preoperative assessments and intraoperative outcomes were compared between the 2 groups. Univariate and multivariate analyses were performed to identify the risk factors for PF.
  
  
  RESULTS
  The two patient groups had similar baseline demographics, preoperative assessments, operative factors, pancreatic factors and pathological results. The overall mortality, morbidity, and PF rates were 1.8%, 48.6%, and 26.1%, respectively. No significant differences were observed in either morbidity or mortality between the two groups. The rate of clinical PF (grade B and grade C PF) was significantly lower in the air insufflation test group, compared with the non-air insufflation test group (6.5% vs 23.1%, P = 0.02). Univariate analysis identified the following parameters as risk factors related to clinical PF: estimated blood loss; pancreatic duct diameter ≤ 3 mm; invagination anastomosis technique; and not undergoing air insufflation test. By further analyzing these variables with multivariate logistic regression, estimated blood loss, pancreatic duct diameter ≤ 3 mm and not undergoing air insufflation test were demonstrated to be independent risk factors.
  
  
  CONCLUSIONS
  Performing an air insufflation test could significantly reduce the occurrence of clinical PF after PD. Not performing an air insufflation test was an independent risk factor for clinical PF.
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Hui
authors: H
authors: Yang
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Xiao-Fei
authors: XF
authors: Lu
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Yun-Fei
authors: YF
authors: Xu
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Hong-Da
authors: HD
authors: Liu
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Sen
authors: S
authors: Guo
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Yi
authors: Y
authors: Liu
authors: Hui Yang, Xiao-Fei Lu, Yun-Fei Xu, Hong-Da Liu, Sen Guo, Yi Liu, Yu-Xin Chen, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Yu-Xin
authors: YX
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Air insufflation test; Morbidity; Pancreatic fistula; Pancreaticoduodenectomy; Surgery