Incidence, Risk Factors, and Treatment of Pancreatic Leakage After Pancreaticoduodenectomy: Drainage versus Resection of the Pancreatic Remnant

Abstract

Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. One group comprised patients undergoing percutaneous or surgical drainage procedures; the other had patients undergoing resection of the pancreatic remnant. RESULTS:Twenty-nine patients (11%) had clinical manifestations of pancreatic leakage, and the mortality in these patients was 28% (overall mortality: 3.7%). Leakage occurred after a median of 5 days (range 1-20). Age, preoperative bilirubin level, and albumin counts were not risk factors for pancreatic leakage. Small pancreatic duct size (Ͻ2mm) (pϽ0.01) and ampullary carcinoma as histopathologic diagnosis (pϽ0.05) were risk factors. The median number of relaparotomies was two (range 0-4) in the drainage group (nϭ21), versus 1.5 (range 1-5) in patients who underwent resection (nϭ8). The median hospital stay was 74 days (range 36-219), versus 55 days (range 22-107) for the drainage and resection groups, respectively (pϽ0.05). Mortality was lower in patients who underwent resection, 38 versus 0% (pϽ0.05). CONCLUSIONS: Leakage of the pancreatic anastomosis is a severe complication after pancreaticoduodenectomy and carries a high mortality rate (28%). Completion pancreatectomy could be performed without additional mortality. In patients with severe and persistent leakage of the anastomosis, early completion pancreatectomy is the treatment of choice. (J Am

An easier method for performing a pancreaticojejunostomy for the soft pancreas using a fast-absorbable suture

“…We examined a high risk group of pancreatic fistula in which the pancreatic texture was soft and the pathology confirmed the absence of fibrosis and pancreatitis change. Nevertheless, the incidences were comparable to the overall incidences of the previous reports using these definitions [1,3,6,7,12,13,22,29] , or were even lower than those in cases restricted to the soft pancreas [9,10] . In a current objective definition by the ISGPF classification scheme, Pratt et al [35] reported an overall incidence of 11.9% in Grade B fistula and 3.4% in Grade C fistula, which were comparable with our results of 14.4% in Grade B fistula and 1.6% in Grade C fistula.…”

“…The incidence is estimated to be 5% to 30% [1,[5][6][7]34,35] , which varies according to the definition [34,35] . Many risk factors for pancreatic fistula have been disclosed, among which the most significant factors are thought to be a soft pancreatic texture, a narrow pancreatic duct, and a high output of pancreatic juice [3,[8][9][10][11][12][13] . Pancreaticoenterostomy is the most physiologic method to deal with the remnant pancreatic stump, because the continuity of the pancreatic exocrine and intestinal functions can be restored [37][38][39] .…”

“…The occurrence of Grade B or C fistulas is included in the postoperative morbidity. A delayed gastric emptying is defined as the need for nasogastric drainage for more than 10 d [2,7,12] , or as the delay of the resumption of a regular diet beyond 14 d postoperatively [36] . Computed tomography (CT), either a helical CT or a multidirector row CT, was performed serially before discharge and on the third and sixth postoperative month to rule out cancer recurrence.…”

“…Many factors have been identified that are associated with an increased incidence of this complication. Among them, a small pancreatic duct size with a soft pancreas creates one of the technical hurdles to the completion of the anastomosis, and is known to be a risk factor for major leakage [3,[8][9][10][11][12][13] . Several methods have been advocated to reduce the occurrence of leakage [5,[14][15][16][17][18][19][20][21] , but the best technique is still a subject of debate [22][23][24][25][26][27][28][29] .…”

Pancreaticoduodenectomy in a Government Medical College—Should We Proceed!!!

“…In the great majority of cases pancreatic fistula responds well to conservative management with octreotide but high out fistulas and cases not responding to conservative management may require operative intervention [14]. Operative options available for pancreatic fistula are relaparotomy and drainage, repair of anastomotic leakage site or completion pancreatectomy [15][16][17]. But relaparotomy in these patients adds a greater risk and usually have a poorer prognosis.…”