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Association between Main Pancreatic Duct Size, Comorbidities, and Fistula Formation after Whipple Procedure for

Alexandra E Adams1, Satyam K Ghodasara1, Jana K Elsawwah1

  • 1Department of Surgery, Morristown Medical Center, Morristown, New Jersey.

Southern Medical Journal
|June 2, 2026
PubMed
Abstract

Insights

A small main pancreatic duct (<3 mm) after a Whipple procedure is linked to increased complications like pancreatic fistula. Preoperative CT scans can help predict and manage these risks.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Medical Imaging

Background:

  • Abnormal main pancreatic duct (MPD) diameter post-Whipple procedure is linked to complications.
  • Understanding factors influencing postoperative pancreatic fistula is crucial.

Purpose of the Study:

  • To investigate clinical factors associated with MPD diameter variations.
  • To identify perioperative factors influencing pancreatic fistula formation after Whipple procedures.

Main Methods:

  • Analysis of 2019-2021 American College of Surgeons National Surgical Quality Improvement Program data for pancreatic cancer Whipple cases.
  • Comparison of outcomes based on MPD diameter: control (3-6 mm), small (<3 mm), and large (>6 mm).

Main Results:

  • Patients with small MPD (<3 mm) had higher rates of organ space surgical site infection (17.73%) and pancreatic fistula (14.72%) compared to controls (3-6 mm).
  • Soft pancreatic gland texture was more common in the small MPD group.
  • Small duct size (<3 mm) and soft pancreatic texture were independent predictors of pancreatic fistula.

Conclusions:

  • A main pancreatic duct <3 mm is associated with increased postoperative complications after Whipple procedures.
  • These complications impact patient quality of life and healthcare resource use.
  • Preoperative CT measurement of MPD size can aid in complication anticipation and mitigation.

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