Afferent Loop Decompression and Outcomes After Pancreaticoduodenectomy: Hybrid Cohort with Propensity Score Matching

Background Clinically relevant postoperative pancreatic fistula (CR‑POPF) remains a key driver of morbidity after pancreaticoduodenectomy (PD). Afferent loop decompression (ALD) has been proposed to lower intraluminal pressure and reduce the risk of pancreatojejunostomy leak. Methods We conducted a study at a single HPB unit (August 2024–July 2025) with a prospective cohort of 20 consecutive ALD cases compared with 60 propensity score matched historical controls. All the patients included in the study underwent Pylorus Resecting pancreaticoduodenectomy (PRPD) with Pancreaticojejunostomy anastomosis by modified Blumgart technique. Primary outcome was CR‑POPF (ISGPS Grade B/C). Secondary outcomes included delayed gastric emptying (DGE), post‑pancreatectomy hemorrhage (PPH), bile leak, and length of hospital stay. Results Incidence of CR‑POPF was lower in the ALD group (10% vs 20%), however it was not statistically significant. Notably, grade B DGE occurred in 0% of ALD vs 46.7% of non‑ALD patients, and a significantly shorter length of hospital stay (12.2 vs 16.3 days, p < 0.001). PPH and bile leak occurred only among non-ALD patients, though events were infrequent. On univariate analysis, higher CA19‑9 (log‑transformed), BMI, and COPD/bronchial asthma were associated with increased odds of CR‑POPF. Conclusions In this preliminary matched analysis, ALD was associated with markedly lower DGE and length of hospital stay. However, the reduction in CR-POPF did not reach statistical significance.