Implications and Management of Pancreatic Fistulas Following Pancreaticoduodenectomy

Abstract

Main Outcome Measures: Development of a pancreatic fistula (defined as Ͼ30 mL of amylase-rich fluid from drains on or after postoperative day 7, or discharge with surgical drains in place, regardless of amount); the need for additional interventions or total parenteral nutrition; other morbidity; and mortality.Results: Seventy-five patients (12.9%) developed a pancreatic fistula. Fistulas were managed with gradual with-drawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas. The remaining 46 patients (61.3%) had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding; these were classified as high-impact fistulas and closed a mean of 35 days after surgery. Standard 30-day in-hospital mortality was 1.9% for all pancreaticoduodenectomies and 6.7% for those who developed a pancreatic fistula. The overall fistula-related mortality was 9.3% (7 patients), all but 1 of which was related to major hemorrhage.Conclusions: More than one-third of pancreatic fistulas are clinically insignificant (low impact). The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality.

An analysis of risk factors for pancreatic fistula after pancreaticoduodenectomy: clinical impact of bile juice infection on day 1

“…However, the morbidity rate still remains in the range of 30-50% [1][2][3], and postoperative pancreatic fistula (POPF) is the most common complication of pancreaticoduodenectomy, which would lead to not only prolongation of the hospital stay but also lethal morbidity or surgical mortality. The incidence of POPF is reported to be 0-17% base on a variety of definition of pancreatic fistula [4][5][6]. Recently, an international study group of pancreatic fistula (ISGPF) defined POPF by reviewing numerous reported series [7].…”

Pancreatic Anastomosis Disruption Seven Years Post Pancreaticoduodenectomy

“…Pancreatic anastomotic leak remains the leading cause of morbidity with an incidence reaching 20% even in specialized centers [13][14][15][16][17]. Complicated pancreatic anastomotic leak may lead to sepsis and hemorrhage with a mortality rate of up to 40% [8,13,14,18].…”

“…Most pancreatic leaks have been reported as a complication occurring within 10 days postoperatively [5,11,19]. The presentations of late leaks have been reported as occult fistula [16] within a few months postoperatively.…”

Surgery for malignant pleural mesothelioma

“…Other major causes of morbidity are myocardial infarction (1.5%), epicarditis (2.7%), pulmonary complications (7.9%), thrombosis (6.4%), empyema (2.4%), technical (6.1%) and gastrointestinal complications (0.9%). When performed at an experienced, high-volume center, extrapleural pneumonectomy is associated with a perioperative mortality of between 2.2 and 7% [4][5][6][7][8][9][10], comparable to mortality for other oncologic surgeries, for example, esophagectomy [11], pancreaticoduodenectomy [12,13] and hepatectomy [14].…”