Analysis Of Braun Anastomosis In Pancreaticoduodenectomy Of Postoperative Complications

BackgroundPancreaticoduodenectomy (PD) is the standard and effective treatment for periampullary adenocarcinoma and pancreatic cancer, The main objective of the operation is to achieve the best quality of life as long as possible, however, it is clear that the operation carries risk of complications, and sometimes,the postoperative complications overweight the potential benefits of surgery. Though operative technique and postoperative management advanced, pancreaticoduodenectomy remains one of the most formidable abdominal operations for the surgeon. The incidence of postoperative complications remains high at 25% to 60%. The methods of digestive tract reconstruction generally are different, including Child, Whipple, Cattell and PD-Ⅱ. Nowdays Child-method is the mainstream in most domestic professional centers. In order to improve the operation effect and reduce the postoperative complications, much improvement has been made, one of which is attached Braun’s anastomosis to traditional reconstruction.ObjectivesGraphPad Prism analyses the related risk factors of postoperative complications after pancreaticoduodenectomy(PD),including afferent loop obstruction, pancreatic leakage, bile leakage and so on, and discusses the correlation of Braun’s anastomosis and the main complications, providing basis for preoperative guidance and postoperative the prevention of complications.MethodsRetrospective analysis 156patients with pancreaticoduodenectomy for diagnosis of ampullary carcinoma, pancreatic head carcinoma or other around surgical indications, from January 2012 to December 2012 in Shandong university Of Qilu hospital, all with standard PD, there are males 89 cases (57.1%), females 67cases (42.9%); group A, with Brown anastomosis in 96 cases (61.5%) and group B. no Brown anastomosis in 60 cases (38.5%). Through single factor and Binary Logistic, we analysis surgery complications and related risk factors of PD and explore Braun’s anastomosis impact for the prevention of postoperative complications.Results(1)The rate of overall complications are 39.1%(61/156)in patients who underwent PD, 28cases of infection complications (28/156,17.94%), delayed gastric emptying in 15 cases(15/156,9.62%), bleeding complications in 16 cases (16/156,10.26%),input climbing obstruction 15 cases(15/156,9.62%),39cases(39/156,25.00%) of pancreatic fistula, multiple organ dysfunction (MODS) in 4 cases (1.2%),and so on.(2)Single factor analysis hint: age, preoperative total bilirubin(≥ 171.1 umol/L), diabetes, pancreas texture(hard) and pancreatic anastomosis are independent risk factors for postoperative complications. (3)Through X2 analysis and Binary Logistic, the biliary fistula, pancreatic fistula, delayedgastric emptying rate are significantly different between A and B group. (P< 0.05).ConclusionThe patients’ age, preoperative total bilirubin, diabetes,pancreas texture, ways of anastomosis are independent risk factors for postoperative complications. Additional Braun anastomosis of pancreaticoduodenectomy can effectively prevent biliary fistula, pancreatic fistula and delayed gastric emptying.