What are the complications of a pylorus-preserving Whipple (pancreaticoduodenectomy) procedure?

From the Guidelines

Complications of a pylorus-preserving Whipple procedure are significant and may include delayed gastric emptying (DGE), which occurs in approximately 10-25% of patients 1.

Common Complications

• Delayed Gastric Emptying (DGE): DGE is a common complication, occurring in up to 25% of patients, and may require the insertion of a nasojejunal feeding tube in some cases 1.
• Other Potential Complications: Although not explicitly mentioned in the provided evidence, other potential complications of a pylorus-preserving Whipple procedure may include pancreatic fistulae, bile leaks, hemorrhage, and wound infections, which may necessitate interventions such as endoscopic retrograde cholangiopancreatography (ERCP) or broad-spectrum antibiotics.

Management of Complications

• Artificial Nutrition: Artificial nutrition should be considered selectively in patients with DGE of long duration 1.
• Construction of Duodenojejunostomy: Constructing the duodenojejunostomy in an ante-colic fashion may result in less DGE 1.

Note: The evidence level for the provided information is very low, but the recommendation grade is strong 1.

From the Research

Complications of Pylorus-Preserving Whipple Procedure

The complications of a pylorus-preserving Whipple (pancreaticoduodenectomy) procedure include:

• Delayed gastric emptying (DGE), which is one of the most common complications after Whipple surgery 2, 3, 4, 5, 6
• Pancreatoenterostomy leakage, which can occur in up to 16% of patients 6
• Intra-abdominal infection, which can occur in up to 14% of patients 6
• Cholangitis, which can occur in up to 8.9% of patients 6
• Hepaticojejunostomy leakage, which can occur in up to 4.7% of patients 6
• Intra-abdominal hemorrhage, which can occur in up to 3.5% of patients 6
• Upper gastrointestinal hemorrhage, which can occur in up to 3.2% of patients 6
• Duodenojejunostomy leakage, which can occur in up to 2.0% of patients 6
• Stomal ulcer, which can occur in up to 3.6% of patients 6
• Liver abscess, which can occur in up to 1.2% of patients 6
• Glucose intolerance, which can occur in up to 10% of patients 6
• Diabetes, which can appear or deteriorate after the procedure 6
• Postoperative body weight loss, which can occur in up to 62% of patients 6

Factors Associated with Complications

Several factors are associated with an increased risk of complications after a pylorus-preserving Whipple procedure, including:

• Male sex, which is associated with an increased risk of pancreatoenterostomy leakage 6
• Soft consistency of the pancreas, which is associated with an increased risk of pancreatoenterostomy leakage 6
• Establishment of gastrostomy, which is associated with an increased risk of delayed gastric emptying 6
• Length of the preserved duodenum, which is associated with an increased risk of delayed gastric emptying 6
• Gastric juice output, which is associated with an increased risk of delayed gastric emptying 6
• Length of gastric tube placement, which is associated with an increased risk of delayed gastric emptying 6
• Administration of cisapride, which is associated with a decreased risk of delayed gastric emptying 6
• Billroth I reconstruction, which is associated with an increased risk of diabetes 6
• Pancreatogastrostomy, which is associated with an increased risk of diabetes 6
• High American Society of Anesthesiologist (ASA) score, which is associated with an increased risk of diabetes 6
• Pancreatoenterostomy leakage, which is associated with an increased risk of diabetes 6