Impact of previous abdominal surgery on perioperative outcomes of laparoscopic pancreaticoduodenectomy: a propensity score matching study.

Laparoscopic pancreaticoduodenectomy (LPD) is a complex procedure. The impact of different types of previous abdominal surgeries (PAS) on its perioperative outcomes remains unclear. Clinical data of 794 LPD patients were collected and divided into major-PAS, minor-PAS, and no-PAS groups based on PAS type and extent. Patients with current or previous complicated intra-abdominal infectious conditions were excluded. Propensity score matching (PSM, 1:2:4) was performed using baseline variables. Intraoperative and postoperative outcomes were compared among groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were performed as sensitivity analyses, with an exploratory subgroup analysis by previous surgical approach. After PSM, 39 major-PAS, 78 minor-PAS, and 156 no-PAS patients were included. Compared with no PAS, major PAS was associated with higher rates of conversion to open surgery (p = 0.010), overall postoperative complications (p = 0.014), incision infection (p = 0.005), and abdominal infection (p = 0.009). Compared with minor PAS, major PAS was also associated with higher rates of conversion to open surgery (p = 0.010) and incision infection (p = 0.003). No significant differences were observed between the minor-PAS and no-PAS groups. Multivariable regression and IPTW analyses provided supportive findings that were generally consistent with the PSM results. Previous open surgery was associated with a higher conversion rate than previous minimally invasive surgery (p = 0.036). In carefully selected patients without documented complicated intra-abdominal infection treated at a high-volume center, minor PAS was not significantly associated with adverse perioperative outcomes after LPD, whereas major PAS was associated with higher risks of conversion to open surgery and infection-related complications.