Management of Complications After Pancreaticoduodenectomy: A Narrative Review of Pathophysiology and Treatment Strategies

Pancreaticoduodenectomy (PD), or the Whipple procedure, remains the cornerstone operation for malignant and select benign diseases of the pancreatic head and periampullary region. Despite advances in surgical techniques and perioperative management, PD continues to be associated with high morbidity. Common complications such as postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and postpancreatectomy hemorrhage (PPH) significantly influence recovery, healthcare costs, and long-term outcomes. A comprehensive literature review was conducted using PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases from inception to August 2025. Relevant studies, meta-analyses, clinical trials, and consensus guidelines in English were included if they addressed the incidence, pathophysiology, risk factors, diagnosis, management, or prevention of complications following PD. Data were synthesized to summarize contemporary management approaches and emerging innovations. POPF, DGE, and PPH remain the most frequent and clinically impactful complications. Advances in interventional radiology, including percutaneous drainage and endovascular embolization, have reduced reoperation rates and mortality. Supportive care-encompassing nutritional optimization, infection control, and prokinetic therapy-forms the foundation of management. Preventive strategies such as Enhanced Recovery After Surgery (ERAS) pathways, selective somatostatin analogue use, and early drain removal have shown improved outcomes. Emerging areas include artificial intelligence (AI)-based predictive models, omics-derived biomarkers, and minimally invasive or hybrid interventions. Effective management of PD complications requires a multidisciplinary, evidence-based, and patient-centered approach. Integration of interventional, pharmacologic, and preventive strategies, combined with predictive technologies and standardized definitions, is essential to reduce morbidity and enhance survival after PD.