Treatment of Postoperative Pancreatic Fistula Following Pancreatic Resection
Journal of Gastrointestinal & Digestive System
Objective: Pancreatic resection is the only potentially curative modality in patients with carcinoma of the pancreas and periampullary region. Morbidity associated with pancreatic resections remains high with the most common cause of complications being pancreatic fistula (PF). PF occurs not only after pancreatic resections, it can develop after pancreatic trauma and acute or chronic pancreatitis as well. As the PF occurring after pancreatic resection may have different course than in other
... e than in other causes, the management is also different. The aim of this study was to evaluate our own results of pancreatic resections with focus on the treatment of PF. Methods: Hospital records from patients who underwent pancreatic resection from January 2010 through December 2012 were identified from our prospectively entered pancreatic surgery database. The postoperative management was standardized for all patients. Outputs from all drains were recorded daily. The amylase concentration was measured on postoperative day 3. If the amylase concentration was above three times the normal serum value, the drain was kept in place and the measurement was repeated every other day. Postoperative complications and their treatment were recorded into our database. Results: During the 3-year period of the study, 78 pancreatic resections were performed. Forty patients had one or more complications. The morbidity rate was 51.2%. The in-hospital mortality was 3.8%. The mean hospital stay for all the patients was 19 days and the hospital stay for patients without any complication was 12 days. Twentyeight patients (35.9%) had pancreatic fistula according to the ISGPF definition. The PF therapy was based on the fistula severity and consisted of conservative measures in the majority of cases. Interventions for the treatment of PF included CT-guided drainage of peripancreatic collections or abscesses in 7 cases, angiography with embolization of pseudoaneurysms in 4 cases and reoperations in 4 cases. Conclusion: Postoperative pancreatic fistula remains a significant concern. In particular, delayed postoperative hemorrhage associated with PF is a serious complication and has a high mortality rate.