A Comparative Study of Intra-Operative and Post-Operative Profile of Patients With and Without Stent Undergoing Whippleʼs Pancreaticoduodenectomy

Introduction: Whipple's pancreaticoduodenctomy is a common surgical procedure performed for pathology in the duodenum, pancreatic head and uncinate process, ampullary structures and the common bile duct. It has been advocated recently that routine pre operative stenting of patients with obstructive jaundice is not advisable. However there are still a few indications where pre-operative stenting is done. This study was performed to evaluate the intra operative and post operative profiles of patients with stent and those without undergoing Whipple's pancreaticoduodenectomy. Methods: This study was performed in HCG Hospital, Bangalore. 64 patients who underwent Whipple's pancreaticoduodenectomy between October 2015 and February 2017 have been included in this study. The factors that were assessed were intra operative blood transfusions, number of in-patient days spent in the hospital post surgery, percentage of lymph nodes that were positive for malignancy among the lymph nodes that were enlarged on pre operative imaging and intra operatively. Results: It was identified in this study that patients who had a stent placed pre operatively had significantly more number of days spent in the hospital as inpatients, had more intra operative blood transfusions. The percentage of enlarged lymph nodes that were positive for malignancy in patients who had pre operative stents was significantly lesser than those who did not have stents placed preoperatively. Conclusion: The authors conclude that although there are still few indications where pre operative stenting is advised in patients undergoing Whipple's pancreaticoduodenectomy, it has to be borne in mind that pre operative stenting is associated with significant intra operative and post operative morbidity and the surgeon might have to deal with significant number of enlarged lymph nodes of inflammatory pathology rather than malignancy.