Table 2.
Items on the questionnaire and answers from centres performing more or fewer than 50 Whipple procedures per year
| Items | Answer options | Centres performing >50 Whipple procedures per year (n = 28) | Centres performing <50 Whipple procedures per year (n = 27) | P-value | ||
|---|---|---|---|---|---|---|
| n | % | n | % | |||
| Type of anastomosis during Whipple procedure | Pancreaticojejunostomy | 22 | 79% | 16 | 59% | 0.085 |
| Pancreaticogastrostomy | 4 | 14% | 3 | 11% | ||
| Both | 2 | 7% | 8 | 30% | ||
| Pancreatic stump treatment during DP | Simple closure of the main pancreatic duct | 9 | 32% | 17 | 63% | 0.031 |
| Suture of the pancreatic stump | 24 | 86% | 21 | 78% | 0.503 | |
| Pancreaticojejunostomy | 0 | 0% | 2 | 7% | 0.236 | |
| Stapling | 14 | 50% | 10 | 37% | 0.418 | |
| Omental plug | 3 | 11% | 2 | 7% | 1.000 | |
| Use of prophylactic drains after Whipple procedure | No | 2 | 7% | 2 | 7% | 0.452 |
| Yes, with an active vacuum suction | 8 | 29% | 12 | 44% | ||
| Yes, with free drainage | 18 | 64% | 13 | 48% | ||
| Use of prophylactic drains after DP | No | 3 | 11% | 2 | 7% | 0.622 |
| Yes, with an active vacuum suction | 8 | 29% | 11 | 41% | ||
| Yes, with free drainage | 17 | 61% | 14 | 52% | ||
| Criteria for removing drain after Whipple procedure | No specific criteria | 3 | 11% | 3 | 11% | 0.148 |
| When output of amylase-rich fluid is low | 23 | 82% | 17 | 63% | ||
| When output of amylase-rich fluid is low and imaging shows no residual collection | 2 | 7% | 7 | 26% | ||
| Criteria for removing drain after DP | No specific criteria | 3 | 11% | 4 | 15% | 0.044 |
| When output of amylase-rich fluid is low | 24 | 86% | 16 | 59% | ||
| When output of amylase-rich fluid is low and imaging shows no residual collection | 1 | 4% | 7 | 26% | ||
| Nutrition after fistula diagnosis (after Whipple procedure) | No oral nutrition and total enteral nutrition using a feeding tube | 7 | 25% | 9 | 33% | 0.732 |
| No oral nutrition and TPN | 8 | 29% | 8 | 30% | ||
| Total oral nutrition | 13 | 46% | 10 | 37% | ||
| Nutrition after fistula diagnosis (after DP) | No oral nutrition and total enteral nutrition using a feeding tube | 2 | 7% | 3 | 11% | 0.437 |
| No oral nutrition and TPN | 4 | 14% | 7 | 26% | ||
| Total oral nutrition | 22 | 79% | 17 | 63% | ||
| Oral feeding after TPN (after Whipple procedure) | This decision is not based on the status of the PF | 14 | 50% | 11 | 41% | 0.424 |
| When the PF is healed | 2 | 7% | 5 | 18% | ||
| When the PF output decreases | 12 | 43% | 11 | 41% | ||
| Oral feeding after TPN (after DP) | This decision is not based on the status of the PF | 15 | 54% | 12 | 44% | 0.706 |
| When the PF is healed | 1 | 4% | 2 | 7% | ||
| When the PF output decreases | 12 | 43% | 13 | 48% | ||
| Somatostatin use (after Whipple procedure) | Intraoperatively in all cases | 4 | 14% | 7 | 26% | 0.491 |
| Intraoperatively in cases of soft pancreas only | 9 | 32% | 11 | 41% | ||
| Never | 4 | 14% | 1 | 4% | ||
| Once a PF appears | 7 | 25% | 5 | 18% | ||
| Preoperatively in all cases | 4 | 14% | 3 | 11% | ||
| Somatostatin use (after DP) | Intraoperatively in all cases | 3 | 11% | 7 | 26% | 0.511 |
| Intraoperatively in cases of soft pancreas only | 6 | 21% | 7 | 26% | ||
| Never | 6 | 21% | 5 | 18% | ||
| Once a PF appears | 11 | 39% | 6 | 22% | ||
| Preoperatively in all cases | 2 | 7% | 2 | 7% | ||
| Somatostatin duration (after Whipple procedure) | 7 days | 12 | 43% | 12 | 44% | 0.679 |
| <7 days | 5 | 18% | 5 | 18% | ||
| >7 days | 3 | 11% | 3 | 11% | ||
| Never use it | 4 | 14% | 1 | 4% | ||
| Until the PF heals | 4 | 14% | 6 | 22% | ||
| Somatostatin duration (after DP) | 7 days | 9 | 32% | 10 | 37% | 0.676 |
| <7 days | 4 | 14% | 5 | 18% | ||
| >7 days | 3 | 11% | 2 | 7% | ||
| Never use it | 7 | 25% | 3 | 11% | ||
| Until the PF heals | 5 | 18% | 7 | 26% | ||
| Antibiotics (after Whipple procedure) | In cases of suspected infection | 15 | 54% | 14 | 52% | 0.628 |
| Never prescribe antibiotics | 2 | 7% | 1 | 4% | ||
| Systematically after surgery (prophylactic) | 11 | 39% | 11 | 41% | ||
| Systematically when PF appears | 0 | 0% | 1 | 4% | ||
| Antibiotics (after DP) | In cases of suspected infection | 15 | 54% | 14 | 52% | 0.999 |
| Never prescribe antibiotics | 2 | 7% | 2 | 7% | ||
| Systematically after surgery (prophylactic) | 10 | 36% | 10 | 37% | ||
| Systematically when PF appears | 1 | 4% | 1 | 4% | ||
| Imaging strategy (after Whipple procedure) | Before removing the prophylactic drains | 0 | 0% | 3 | 11% | 0.033 |
| In all cases, once a PF has been diagnosed | 5 | 18% | 10 | 37% | ||
| Only when an infected intra-abdominal collection is suspected | 23 | 82% | 14 | 52% | ||
| Imaging strategy (after DP) | Before removing the prophylactic drains | 0 | 0% | 3 | 11% | 0.030 |
| In all cases, once a PF has been diagnosed | 5 | 18% | 9 | 33% | ||
| Only when an infected intra-abdominal collection is suspected | 23 | 82% | 15 | 56% | ||
| Criteria for re-laparotomy (after Whipple procedure) | High PF output | 0 | 0% | 0 | 0% | 0.491 |
| Symptomatic collection which is undrainable by interventional radiology | 26 | 93% | 27 | 100% | ||
| For both cases | 2 | 7% | 0 | 0% | ||
| Criteria for re-laparotomy (after DP) | High PF output | 0 | 0% | 0 | 0% | 1.000 |
| Symptomatic collection which is undrainable by interventional radiology | 27 | 96% | 27 | 100% | ||
| For both cases | 1 | 4% | 0 | 0% | ||
| Patient discharge (after Whipple procedure) | Once the PF is draining well (drain in situ) and oral nutrition is well tolerated | 25 | 89% | 17 | 63% | 0.029 |
| Once the PF has completely healed | 3 | 11% | 10 | 37% | ||
| Patient discharge (after DP) | Once the PF is draining well (drain in situ) and oral nutrition is well tolerated | 26 | 93% | 20 | 74% | 0.063 |
| Once the PF has completely healed | 2 | 7% | 7 | 26% | ||
PF, pancreatic fistula; DP, distal pancreatectomy; TPN, total parenteral nutrition.