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- W3150424871 abstract "Introduction: Routine preoperative biliary drainage prior to a Whipple's procedure is still common in the UK. Recent NICE guidelines (2018) recommend proceeding to unstented surgery in suitable patients. There is level 1 evidence that demonstrates preoperative biliary stenting increases post-operative complications as opposed to early surgery. The study was done to review a single centre experience of early outcomes following stented versus unstented Whipple's procedure. Methods: This is a retrospective review of a prospectively maintained database. 104 patients who underwent a Whipple procedure in 3 years were included. 46 patients underwent preoperative stenting and 58 had Whipple's without stenting. The primary outcomes were rates of pancreatic fistula, bleeding, intra-abdominal collection and wound infections within 90 days post-surgery. The analysis was done using descriptive statistics and non-parametric tests. A two sided significance of p value < 0.05 was considered, with 95% confidence intervals. Results: In Whipple's with preoperative biliary stenting - postoperative pancreatic fistula was seen in 19.56% of patients, bleeding in 10.86%, intra-abdominal collections in 19.56% while wound infection was noted in 26.08%. In the unstented group 27.58% had pancreatic fistula, 24.13% had collections and 5.175% had wound infection. In our study, patients with unstented Whipple's had similar outcomes (albeit not statistically significant) to stented Whipple's, except the rate of wound infection, which was more in stented (p value -0.004). Conclusion: Unstented Whipple's has the potential of shortening the patient pathway and time to definitive treatment. Hence, we advocate increasing adoption of the surgery first approach in suitable patients.Tabled 1Analysis of outcomes - primary and secondary.OutcomesUnstented (n=58)Stented (n=46)p ValuePOPF16 (27.58%)9 (19.56%)0.342Bleeding3 (5.1755%)5 (10.86%)0.461Intra-abdominal collection14 (24.13%)9 (19.56%)0.545Wound infection3 (5.175%)12 (26.08%)0.004Delayed gastric emptying8 (13.8%)6 (13.04%)0.911Re-exploration3 (5.175%)5 (10.8%)0.461Readmissions1 (1.7%)2 (4.34%)0.582Death within 90 days5 (8.6%)3 (6.52%)0.611Death within 30 days2 (3.4%)2 (4.34%)0.612 Open table in a new tab" @default.
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- W3150424871 date "2021-01-01" @default.
- W3150424871 modified "2023-10-16" @default.
- W3150424871 title "Preoperative biliary stenting versus unstented pancreaticoduodenectomy (Whipple's Procedure) - a comparative study of early outcomes" @default.
- W3150424871 doi "https://doi.org/10.1016/j.hpb.2020.11.705" @default.
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