Application of air insufflation to prevent clinical pancreatic fistula after pancreaticoduodenectomy

Table 1 Baseline demographics

	AIT group(n = 46)	Non-AIT group(n = 65)	P value
Age (yr)	55.3 ± 11.5	58.1 ± 7.8	0.15
Gender			0.64
Male	24	31
Female	22	34
Main presenting symptom
Jaundice	25	35	0.96
Abdominal pain	10	24	0.09
Cholangitis	3	8	0.50
ASA			0.64
II	41	56
III	5	9
Preoperative ALT	226.0 ± 204.2	193.6 ± 205.0	0.41
Preoperative AST	150.2 ± 152.1	138.3 ± 150.7	0.68
Preoperative bilirubin (μmol/L)	189.0 ± 171.9	137.11 ± 131.8	0.08
Preoperative albumin (g/L)	66.2 ± 8.5	65.8 ± 7.8	0.81
Presence of comorbid illness	23	27	0.38
Mellitus diabetes	8	4	0.06
Chronic pulmonary disease	2	4	0.68
Artery hypertension	9	13	0.96
Coronaropathy	4	6	1.00
Preoperative biliary drainage			0.60
Yes	21	33
No	25	32
Smoking	13	14	0.42

ASA: American Society of Anesthesiologists; ALT: Alanine aminotransferase; AST: Aspartate transaminase; AIT: Air insufflation test.

Table 2 Intraoperative data and pathological diagnoses

	AIT group(n = 46)	Non-AIT group(n = 65)	P value
Operative factors
Combined vascular resection cases	1	2	1.00
Duration of operation (min)	372.9 ± 106.5	344.7 ± 86.4	0.13
Estimated blood loss (mL)	347.3 ± 195.7	289.7 ± 159.9	0.09
Blood transfusion cases	13	20	0.78
Pancreatic factors
Pancreatic duct diameter			0.76
≤ 3 mm	31	42
> 3 mm	15	23
Pancreatic texture			0.58
Soft	34	51
Hard	12	14
Pancreatic anastomosis technique			0.17
Duct to mucosa anastomosis	20	20
End to side invagination anastomosis	26	45
Pathological diagnoses			0.66
Malignant disease	39	57
Pancreatic carcinoma	11	17	0.79
Ampullar carcinoma	10	12	0.67
Cholangiocarcinoma	8	12	0.89
Duodenal carcinoma	10	16	0.72
Benign diseases	7	8

Data are expressed as mean ± SD. AIT: Air insufflation test.

Table 3 Postoperative outcomes

	AIT group(n = 46)	Non-AIT group(n = 65)	P value
Hospital mortality	1	1	1.00
Morbidity	20	34	0.36
Pancreatic fistula	9	20	0.19
Grade A	6	5	0.54
Grade B	2	8	0.02
Grade C	1	7
Delayed gastric emptying	5	7	1.00
Hemorrhage	3	8	0.50
Bile fistula	3	8	0.50
Intraabdominal collection	4	10	0.30
Intraabdominal infection	3	12	0.07
Wound infection	3	8	0.50
Pneumonia	1	3	0.87
Urinary tract infection	1	1	1.00
Deep vein thrombosis	1	0	0.86
Heart failure	0	2	0.63
Myocardial infarction	1	0	0.86
Hospital stay	31.2 ± 11.3	36.0 ± 14.6	0.07

AIT: Air insufflation test.

Table 4 Univariate analysis of risk factors for clinical pancreatic fistula

	Clinical PF group (n = 18)	Non-clinical PF group (n = 93)	P value
Age (yr)	56.6 ± 9.8	56.4 ± 10.3	0.96
Gender			0.58
Male	10	45
Female	8	48
ASA			0.55
II	17	80
III	1	13
ALT (U/L)	263.8 ± 298.9	191.8 ± 179.7	0.17
AST (U/L)	171.6 ± 232.3	135.8 ± 130.2	0.36
Preoperative bilirubin (μmol/L)	185.8 ± 159.8	151.2 ± 149.1	0.38
Preoperative albumin (g/L)	68.1 ± 6.8	65.6 ± 8.2	0.23
Presence of comorbid illness	5	38	0.30
Mellitus diabetes	0	11	0.27
Chronic pulmonary disease	1	5	1.00
Artery hypertension	1	16	0.37
Coronaropathy	3	6	0.33
Preoperative biliary drainage			0.25
Yes	11	43
No	7	50
Smoking			0.84
Yes	5	22
No	13	71
Operative factors
Combined vascular resection	1	2	0.42
Duration of operation (min)	392.8 ± 103.3	349.2 ± 93.2	0.08
Estimated blood loss (mL)	428.9 ± 272.6	290.2 ± 144.0	0.05
Blood transfusion cases	7	26	0.35
Pancreatic factors
Pancreatic duct diameter			0.02
≤ 3 mm	16	57
> 3 mm	2	36
Pancreatic texture			0.66
Soft	15	70
Hard	3	23
Pancreatic anastomosis			0.02
Duct to mucosa anastomosis	2	38
Invagination anastomosis	16	55
Air insufflation test			0.02
Yes	3	43
No	15	50
Pathological diagnoses			0.96
Malignant disease	15	81
Pancreatic carcinoma	4	20	1.00
Ampullar carcinoma	1	17	0.32
Cholangiocarcinoma	4	15	0.78
Duodenal carcinoma	6	17	0.26
Benign diseases	3	12

ASA: American Society of Anesthesiologists; ALT: Alanine aminotransferase; AST: Aspartate transaminase; PF: Pancreatic fistula.