The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy.

INTRODUCTION: Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a serious complication. We hypothesized that the amount of fatty tissue in the pancreatic parenchyma could be associated with the occurrence of PF after PD with pancreatogastrostomy.

MATERIAL AND METHODS: From January 2004 to December 2006, 111 consecutive patients underwent PD with pancreatogastrostomy. The microscopic amount of fatty tissue in the pancreas was evaluated.

RESULTS: The morbidity and mortality rates were 35.1% and 1.8%, respectively. PF occurred in 10.8% (n = 12). PF was of grade A in nine, grade B in two, and grade C in one patient. Univariate analysis showed that a body mass index (BMI) > 25 (P = 0.035), a soft pancreatic parenchyma (P = <0.003), a pancreatic duct size <3 mm (P = 0.015), and a fatty infiltration of the pancreas of more than 10% (P = 0.0003) were associated with the occurrence of PF. The advanced age (P = 0.049) and the BMI (P < 0.0001) were significantly associated with the presence of >10% of pancreatic fat.

CONCLUSIONS: A pancreatic fatty infiltration of the pancreas over 10% constitutes a risk factor for PF after PD. Age and BMI are useful preoperative predictors of the percentage of pancreatic fat.