Elsevier

Surgery

Volume 140, Issue 4, October 2006, Pages 561-569
Surgery

Central Surgical Association
Current management of pancreatic fistula after pancreaticoduodenectomy

Presented at the 63rd Annual Meeting of the Central Surgical Association, Louisville, Kentucky, March 9-11, 2006.
https://doi.org/10.1016/j.surg.2006.07.009Get rights and content

Background

Pancreatic fistula (PF) is a major and serious complication following pancreaticoduodenectomy (PD). The purpose of this study was to outline our management of PF after PD.

Methods

A retrospective review of a prospectively collected database of 396 patients undergoing PD for various indications at Loyola University Medical Center and Hines Veterans Administration Hospital from July 1, 1990, to December 31, 2005. Patients were divided group 1 (no PF) and group 2 (PF). Each group was compared regarding preoperative, intraoperative, and postoperative outcomes.

Results

Of the patients included in the study, 65 patients (16%) developed a PF. PF was more common after PD for ampullary neoplasms (28%), duodenal neoplasms (35%), and serous cystic neoplasms (44%), and was uncommon after PD for pancreatic cancer (6%). Associated complications with PF was 51% when compared with patients with no PF (21%; P ≤ .001). Duration of hospital stay was 16 days in PF versus 9 days in no PF (≤.001). Intraoperative blood loss was greater in the PF versus no PF group (P = .01). Clinically serious postoperative complications in the PF versus no PF group were mortality (P = .03), intraabdominal abscess (P ≤ .001), wound infection (P ≤ .001), hemorrhage (P = .01), cardiac (P ≤ .001), bile leak (P ≤ .001), and reoperation (P = .02). Of the 62 surviving patients with PF, 36 (58%) were treated with maintenance of oral diet, 25 (40%) with parenteral nutrition, and 1 (1.6%) required surgery for closure of PF.

Conclusions

PF is a serious complication after PD and is associated with substantial mortality and other complications. The majority of patients with PF can be managed conservatively with either maintenance of oral diet or parenteral nutrition until closure of the PF.

Section snippets

Methods

A retrospective review of a prospectively collected database of 396 patients undergoing PD for various indications at Loyola University Medical Center and Hines VA Hospital from July 1, 1990, to December 31, 2005, was conducted. More than 80% of the patients underwent PD at Loyola University Medical Center.

This review included demographics such as age and sex; certain laboratory data, such as alkaline phosphatase and albumin; the use of preoperative endoscopic retrograde

Results

From July 1, 1990, to December 31, 2005, 396 patients underwent PD at Loyola University Medical Center and Hines Veterans Administration Hospital. The indications for PD are listed in Table I. The 2 major indications for PD were pancreatic adenocarcinoma in 167 patients (42%) and ampullary carcinoma in 61 patients (15%). Of the 396 patients, 65 (16.4%) developed a PF. The median time to start of a general diet was 7 days. The median drain amylase level was 13,841 u/l (range, 339 to 274,736

Comments

It is clear from the available literature and from our experience that PF after PD is a common complication and associated with substantial mortality and morbidity. Failure of the pancreaticoenteric anastomosis results not only in a fistula but also increases other complications such as intraabdominal abscess, wound infection, hemorrhage, cardiac complications, bile leaks, the need for reoperation, and, of course, mortality. It is to be noted that the clear definition of a pancreatic fistula

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