The impact of externalized pancreatic stents in our practice: A comparison of outcomes after pancreaticoduodenectomy in two time periods

Am J Surg. 2025 Jan:239:116004. doi: 10.1016/j.amjsurg.2024.116004. Epub 2024 Oct 6.

Abstract

Background: Postoperative pancreatic fistula is a severe complication of pancreaticoduodenectomy. Using an externalized pancreatic stent is a potential mitigation strategy not previously studied in Latin America.

Methods: Pancreaticoduodenectomies performed in a single center between 2006 and 2019 were retrospectively analyzed. Clinical variables were collected with a 90-day follow-up according to stent intervention: externalized stent (ES), internal stent (IS), or no stent. Before and after ES implementation (2016) periods were also compared.

Results: Out of 237 patients, 77 (32.5 ​%) had an ES, 24 (10.1 ​%) an IS, and 136 (57.4 ​%) none. No difference was found in the overall incidence of POPF. The use of an ES was associated with less type C POPF, despite having an increased risk for fistula development. PD performed after 2016 were also associated with a reduced incidence of type C POPF, surgical reintervention requirement, POPF-associated mortality, and intrahospital stay.

Conclusions: The use of an ES is a low-cost intervention that can mitigate POPF severity in high-risk patients.

Keywords: Externalized stent; Fistula risk score; Latin America; Pancreatic fistula; Pancreaticoduodenectomy.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pancreatic Fistula* / epidemiology
  • Pancreatic Fistula* / etiology
  • Pancreatic Fistula* / prevention & control
  • Pancreatic Neoplasms / surgery
  • Pancreaticoduodenectomy* / adverse effects
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Retrospective Studies
  • Stents* / adverse effects
  • Treatment Outcome