Management of Pancreatic Fistulas

Martín, Félix; Rossi, Ricardo L.; Munson, J. Lawrence; ReMine, Stephen G.; Braasch, John W.

doi:10.1001/archsurg.1989.01410050061012

Cited by 65 publications

(34 citation statements)

References 7 publications

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“…Tsiotos et al [3] have reported a fistula output of 50–500 ml/day in all their patients, whereas Fielding et al [8] had 79% patients with output <500 ml (their inclusion criterion was fistula output >200 ml/day). Other than the demonstration of the communication with the pancreatic duct, presence of high levels of fluid amylase values was seen in all series including ours [1,2,3,4, 8]. …”

Section: Discussionmentioning

confidence: 60%

“…EPF has been reported to occur in 20–44% of patients following surgical management of necrotizing pancreatitis [1,2,3,4]. The exact pathogenesis of EPF is unclear; multiple factors are possibly involved and these have not been fully defined [2].…”

Section: Discussionmentioning

confidence: 99%

“…Ho and Frey [2]had suggested conservative management for a period of 1 year before intervention, while others suggest investigating the nature of the fistula after 30 days (by ERP or fistulogram) to decide the type of intervention [1, 2, 11]. Other authors have managed fistula up to 500 ml/day conservatively [1, 3]. The critics of the conservative approach to EPF suggest early intervention in view of the significant morbidity and the poor quality of life associated with EPF.…”

Section: Discussionmentioning

confidence: 99%

“…The morphology and the clinical course of EPF following necrosectomy have been previously addressed by some authors [1,2,3,4]. Our aim was to study the clinical profile, course and outcome of patients with EPF following surgical or percutaneous intervention in acute severe pancreatitis with infective complications.…”

Section: Introductionmentioning

confidence: 99%

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External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

et al. 2005

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Background/Aims: External pancreatic fistula (EPF) is a common sequel to surgical or percutaneous intervention for infective complications of acute severe pancreatitis. The present study was aimed at studying the clinical profile, course and outcome of patients with EPF following surgical or percutaneous management of these infective complications. Methods: A retrospective analysis of clinical data of patients with EPF following intervention (surgical or percutaneous) for acute severe pancreatitis managed between January 1989 and April 2002 recorded on a prospective database was done. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) that could predict early closure of fistula was performed. Results: Of 210 patients with acute severe pancreatitis, 43 (20%) patients developed EPF (mean age 38 (range 16–78) years, M:F ratio 5:1) following intervention for infected pancreatic necrosis (n = 23) and pancreatic abscess (n = 20) and constituted the study group. The fistula output was categorized as low (<200 ml), moderate (200–500 ml) and high (>500 ml) in 29 (67%), 11 (26%) and 3 (7%) patients, respectively. Fifteen patients (35%) had morbidity in the form of abscess (n = 5), bleeding (n = 1), pseudoaneurysm (n = 2) and fever with no other focus of infection (n = 7). Spontaneous closure of the fistula occurred in 38 (88%) patients. The average time to closure of fistula was 109 ± 26 (median 70) days. Fistula closed after intervention in 5 patients (2 after endoscopic papillotomy, 1 after fistulojejunostomy and 2 after downsizing the drains). Of the 38 patients with spontaneous closure, 9 (24%) patients developed a pseudocyst after a mean interval of 123 days of which 7 underwent surgical drainage of the cyst. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) failed to identify any factors that could predict early closure of fistula. Conclusions: EPF is a common sequel following intervention in acute severe pancreatitis. The majority of these are low output fistulae and close spontaneously with conservative management. One-fourth of patients with spontaneous closure develop a pseudocyst as a sequel, requiring surgical management.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

et al. 2005

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“…Laparoscopic distal pancreatectomy (LDP) is gradually becoming the gold standard treatment for benign and malignant neoplasms in the body and tail of the pancreas [1,2]. Traditionally, splenectomy was performed in association with LDP because the spleen lies adjacent to the tail of pancreas and shares the same blood supply.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Laparoscopic Distal Pancreatectomy with or without Splenic Preservation

Jiang

Wang

et al. 2013

Indian J Surg

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Laparoscopic distal pancreatectomy (LDP) has gained large popularity in recent years, although the choice of whether to preserve the spleen has remained inconsistent. The aim of our study was to report our experiences with LDP and to provide evidence for the safety of the operative technique and an evaluation index of splenic function. We retrospectively evaluated all LDPs performed at our institution between March 2008 and February 2012. Cases were divided into a laparoscopic spleen-preserving distal pancreatectomy (LSPDP) group (n = 14) and an LDP with splenectomy (LDPS) group (n =19). Parametric and nonparametric statistical analyses were used to compare perioperative and oncologic outcomes. Demographic characteristics, operating time, length of stay, estimated blood loss, transfusion requirement, pathologic diagnosis, and complication rate were similar between groups. Patients who underwent LDPS tended to have larger masses and lower pancreatic fistula rates, but these differences were not significant. White blood cell (WBC) counts were significantly higher in the LDPS group than in the LSPDP group on postoperative days 1 and 7. To avoid splenectomy-associated complications, preservation of the spleen and especially the splenic vessels are preferred. This procedure can be performed safely and feasibly. Lower postoperative WBC counts may imply better splenic function.

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Risk Analysis of Pancreatic Fistula After Pancreatic Head Resection

Sato

Yamaguchi²,

Chijiiwa³

et al. 1998

Arch Surg

150

118

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Objective: To evaluate the risk factors for pancreatic fistula after pancreatic head resection.Design: Retrospective review. Patients and Intervention:Sixty-two patients who underwent pancreatic head resection with pancreatojejunostomy. We performed an extensive analysis of preoperative and perioperative risk factors for pancreatic fistula.Main Outcome Measures: Pancreatic fistula was defined as high amylase level (Ͼ1000 U/L) in the drainage fluid collected from the peripancreatic drains and/or anastomotic disruption demonstrated radiographically.Results: Nine (15%) of the 62 patients developed pancreatic fistula, and 1 (1.6%) died of intra-abdominal hemorrhage related to the pancreatic fistula. A preoperative normal N-benzoyl-L-tyrosyl-p-aminobenzoic acid test result (P=.01), soft or intermediate pancreatic consistency (P=.04), duodenum-preserving pancreatic head resection for the normal exocrine pancreas (P=.002), and a larger amount of postoperative pancreatic juice output (P=.02) were significant risk factors for pancreatic fistula formation.

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Management of Pancreatic Fistulas

Cited by 65 publications

References 7 publications

External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

Comparison of Laparoscopic Distal Pancreatectomy with or without Splenic Preservation

Risk Analysis of Pancreatic Fistula After Pancreatic Head Resection

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