Decoding grade B pancreatic fistula: a clinical and economical analysis and sub-classification proposal

Abstract

LAPC, initial results suggest CDA is safe. Evaluation of the safety and efficacy of CDA in this setting is ongoing.

Conservative drain management increases the incidence of grade B postoperative pancreatic fistula without increasing serious complications: Does persistent drainage reflect the quality of pancreatic surgery or institutional policy?

“…8 However, in the current ISGPF grading system, grade B POPF is a clinically heterogeneous condition because of its treatment-based definition. 7,9,10 A recent study from Maggino et al reported that the clinical burden of patients with grade B POPF requiring only persistent drainage over 21 days (B-drain) was distinctly lower than that of patients with grade B POPF requiring pharmacologic management or interventional procedures. 9 Moreover, van Hilst et al reported that the clinical course was comparable between patients requiring only persistent drainage over 21 days and those with biochemical leakage (BL).…”

“…7,9,10 A recent study from Maggino et al reported that the clinical burden of patients with grade B POPF requiring only persistent drainage over 21 days (B-drain) was distinctly lower than that of patients with grade B POPF requiring pharmacologic management or interventional procedures. 9 Moreover, van Hilst et al reported that the clinical course was comparable between patients requiring only persistent drainage over 21 days and those with biochemical leakage (BL). 11 These findings raise concerns regarding the utility of persistent drainage over 21 days as a clinically relevant threshold in determining the clinical condition of these patients.…”

“…11 Maggino reported that the rate of patients with grade B-drain was quite different between two institutions in Italy and United States (3.7% and 41.2%). 9 Moreover, recent worldwide study showed that the rate of grade B/C POPF after pancreaticoduodenectomy (PD) was geographically different, implying that the rate of grade B/C POPF was strongly affected by institutional practice. 12 Therefore, in this study, we compared the clinical burden of patients who were treated with persistent drainage for > 21 days, patients who received other treatments for grade B POPF, and patients with BL.…”

HYAL‐1‐induced autophagy facilitates pancreatic fistula for patients who underwent pancreaticoduodenectomy

“…POPF is recognized as a life-threatening complication after PD which occurs in nearly 20% patients. 32,33 The early detection of POPF improves the postoperative monitoring and the management of complications. The risk factors of POPF after PD have been much explored in previous studies.…”

Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

“…Class B and C pancreatic fistulas are defined more strictly than before. Class B pancreatic fistulas require significant clinical interventions such as continuing drainage for more than three weeks or endoscopic and percutaneous drainage [5]. Class C pancreatic fistulas refer to pancreatic fistulas requiring further surgical intervention.…”