Management of Pancreatic Fistulas After Pancreaticoduodenectomy

Open Access
Publisher Website
Google Scholar
Abstract
Pancreaticoduodenectomy (PD) has become an increasingly common and safe operation for selected patients with benign and malignant periampullary disorders. The operative mortality rates reported for many high-volume pancreatic surgical centers are now less than 5%, a dramatic improvement over the rate of 20% often reported during the 1970s. However, the postoperative morbidity rate is still 40% to 50%.1-4 Pancreatic fistula (PF) is the most problematic common complication after PD, and its reported incidence varies from 2% to 28%.1-11 Because many patients who developed PF in the past required reoperation and often died, much effort has been made to minimize its occurrence. This includes the use of the stomach instead of the jejunum for the pancreatic anastomosis, biological adhesives to seal the anastomosis, somatostatin analogues to inhibit pancreatic secretion, and a number of different surgical techniques to fashion the anastomosis. None of these methods have demonstrated a clear advantage.9,12-20 Therefore, prompt recognition and proper management of PF when it does occur are important. While many advocate conservative management of PF,3,6,8 some surgeons still favor aggressive surgical intervention.7,21 To further evaluate our own management strategies and experience with this problem, we conducted a retrospective study of the patients at University of California, Los Angeles (UCLA), Los Angeles, Calif, who developed PFs after PD. Data from patients who had distal pancreatectomy were not analyzed.