After pancreaticoduodenectomy, the most significant determinant of anastomotic leak leading to post-pancreatectomy haemorrhage is failure of which anastomosis?

• A Hepaticojejunostomy (bile duct-to-jejunum)
• B Gastrojejunostomy (stomach-to-jejunum)
• C Pancreaticojejunostomy or pancreaticogastrostomy (pancreatic remnant anastomosis) ✓
• D Duodenojejunostomy in pylorus-preserving Whipple's

Explanation

Postoperative pancreatic fistula (POPF) from the pancreatic anastomosis (pancreaticojejunostomy or pancreaticogastrostomy) is the most dreaded complication of pancreaticoduodenectomy, occurring in 15-25% of cases. Pancreatic juice activation of proteases erodes adjacent vessels, causing delayed post-pancreatectomy haemorrhage (PPH) — the leading cause of mortality after the procedure. Risk factors for POPF include soft pancreatic texture, small duct (<3 mm), and high-fat pancreas. ISGPS grade B and C POPF require interventional/surgical management.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.