الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
There are different surgical techniques for pancreatico-enteric reconstruction after pancreaticoduodenectomy. All these techniques aim to decrease incidence of postoperative pancreatic fistula which is the most important determinant of morbidity and mortality after pancreatico-duodenectomy. Duct-to-mucosa pancreaticojejunostomy remains by far for the pancreatic stump after pancreaticoduodenectomy. A pancreatic duct stent in pancreaticojejunostomy, either internal or external, was used by many surgeons to decrease incidence of postoperative pancreatic fistula.
We conducted this prospective study to compare the outcome of external and internal pancreatic duct stenting in duct-to-mucosa pancreaticojujenostomy after pancreaticoduodenectomy as regards to the incidence rate of post-operative pancreatic fistula and its related morbidity and mortality. We included 30 patients who had pancreaticoduodenectomy operation for malignant and benign diseases of the pancreas and periampullary region and we randomized them into two equal groups either with internal or external pancreatic duct stent. Data were collected prospectively in the form of preoperative patients` characteristics, intraoperative details and postoperative complications.
The incidence of overall postoperative pancreatic fistula defined by ISGPF criteria was significantly higher in the external stent group. Grade C pancreatic fistula showed no significant difference between the external and the internal drainage groups. In patients with soft pancreas, the incidence of pancreatic fistula was similar in both groups. Bile leakage occurred more significantly in external stent group. The incidence of overall morbidity was similar between both groups while mortality was higher in external stent group. The mean postoperative hospital stay was not significantly different between the two studied groups.
We concluded that internal pancreatic duct stent had less incidence of postoperative pancreatic fistula in our patients, while in patients with soft pancreas only, both internal and external stent had similar rate of pancreatic fistula. It simplifies postoperative managements and it might be a better option than external stent in pancreaticojejunostomy after pancreaticoduodenectomy. Therefore, we recommend a conduction of a bigger sample randomized controlled study to compare between internal and external pancreatic duct stent especially in patients with soft pancreas and non-dilated pancreatic duct.