Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection

Abstract

Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy, with a focus on pancreas-visceral fat CT value ratio and serrated pancreatic contour

“…Although various reports have evaluated the optimal pancreatic stump closure method for POPF reduction, no consensus has been established, and further studies are needed to identify a closure method that reduces the incidence of CR-POPF. Furthermore, based on our previous report [ 24 ], a consideration from the perspectives of intraoperative and postoperative management indicated that the inappropriate drainage tube placement and/or number of drain tubes in our department may have increased the number of cases requiring additional intervention and may have also resulted in excessive use of postoperative therapeutic antibiotics. If the drainage is appropriate, the drain can be removed at an early stage; furthermore, if the indication for therapeutic antibiotic use is judged more strictly, then it would not result in Grade B CR-POPF, and there may be more cases that would heal with a biochemical leak (BL).…”

“…The basic postoperative and POPF management used in this study has been described in our previous report [ 24 ]. Prophylactic antibiotics (second-generation cephalosporin) were administered through POD 2.…”

Efficacy of Reinforced Stapler Versus Hand-sewn Closure of the Pancreatic Stump During Pure Laparoscopic Distal Pancreatectomy to Reduce Pancreatic Fistula

“…The patients who underwent L-DP were managed postoperatively as reported. 12 The administration of prophylactic antibiotics was routinely continued through the postoperative day (POD) 2. Prophylactic somatostatin analogs were not routinely used.…”