Do preoperative pancreatic stents increase operative morbidity for chronic pancreatitis?

Recent studies suggest that preoperative placement of bile duct stents increases morbidity after pancreatic surgery. The influence of pancreatic duct stenting on outcome after pancreatic surgery is unknown.

The records of 264 consecutive patients who underwent lateral pancreaticojejunostomy, pancreaticoduodenectomy, or distal pancreatectomy for chronic pancreatitis were retrospectively reviewed and analyzed.

There were 137 patients who received preoperative endoscopic pancreatic stents. The remainder underwent preoperative ERCP without stent placement. Both groups had a similar stage of disease measured by endoscopic, clinical, and histological findings. The overall postoperative morbidity was higher in the stent group (19.7% vs. 42.3%, p<0.001, odds ratio 3.0). Intra-abdominal complications occurred more frequently in the stent group (10.2% vs. 32.8%, p<0.001), including a difference in pancreatic leaks. There was no difference in extra-abdominal complications (10.2% vs. 13.1%) and mortality (1.6% vs. 1.5%).

Patients who undergo pancreatic duct stenting and require surgical drainage at a later point have a threefold increased risk for peri-operative complications. An increase in intra-abdominal complications might be related to stent associated pancreatic duct injuries, stent occlusion, and bacterial colonization of the stent.