Pancreaticoduodenectomy and placement of operative enteral access: Better or worse?

Background: It is unclear whether placement of operative enteral access (OEA) during pancreaticoduodenectomy (PD) correlates with decreased morbidity.

Methods: A retrospective chart review of patients undergoing PD with and without OEA placement between January 2016 and May 2018 was undertaken. Outcomes included length of stay (LOS), 30- and 90-day readmission, initiation of total parenteral nutrition (TPN), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and surgical site infection (SSI).

Results: 69 patients were evaluated; there was a trend toward decreased LOS for patients without OEA (9 vs. 7.5 days, p = 0.07). There were no significant differences in initiation of TPN (9.1% vs 19.4%, p = 0.311), POPF (21.2% vs 11.1%, p = 0.999), DGE (24.2% vs 22.2%, p = 0.999), organ/space SSI (12.1% vs 8.3%, p = 0.702).

Conclusion: OEA placement at the time of PD is not necessarily associated with improved perioperative morbidity and outcomes, suggesting that OEA may not be necessary and should be considered on a case by case basis.

Summary: It is unclear whether placement of operative enteral access (OEA) during pancreaticoduodenectomy (PD) correlates with decreased morbidity. A retrospective review of patients undergoing PD with and without OEA placement between January 2016 and May 2018 was performed, demonstrating that there were no overall significant differences in postoperative complications and outcomes.