Risk Analysis of Pancreatic Fistula After Pancreatic Head Resection

Abstract

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.

Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches

“…Second, a soft pancreas is more easily injured directly or via ischemia by stitches placed between the pancreas parenchyma and the seromuscular layer of the jejunum [20] . Third, a soft pancreas has a good exocrine function, secreting more pancreatic juices rich in proteolytic enzymes [20][21][22] . Prophylactic use of octreotide is expected theoretically to reduce the incidence rate of the pancreatic fistula through decreasing pancreatic juice secretion.…”

Pancreatoduodenectomy - Preventing Complications

“…Amongst all, texture of the gland remains the most important predictive factor. The soft and fatty texture of the pancreas [38][39][40][41][42][43][44][45][46] with a non dilated duct (duct size < 3 mm) [45,46] has a higher incidence of fistula when compared to fibrotic/atrophic pancreas with a dilated duct. Increased secretion of pancreatic juice is seen in patients with soft or normal pancreatic remnant and is associated with increased rates of POPF [41].…”

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

“…Although some authors [2,3] routinely perform postoperative CT and include CT in the criteria for pancreatic fistula diagnosis, others [17] do not recommend CT in the diagnosis of pancreatic fistula because of the high prevalence of transient intraabdominal fluid collections after pancreaticoduodenectomy [22]. In an effort to clarify the role of CT in the diagnosis of pancreatic fistula after pancreaticoduodenectomy, we evaluated the sensitivity and specificity of routine CT on postoperative day 7 in patients at high risk of pancreatic fistula.…”

“…Pancreatic fistula diagnosed with repeated assays of pancreatic enzymes in peripancreatic fluid drainage [11,14,16] © American Roentgen Ray Society P ancreaticoduodenectomy is safe in the management of various malignant and benign diseases of the pancreatic head and periampullary region. Although the mortality rate has decreased to approximately 1-2% at high-volume centers, the morbidity rate ranges from 30% to 50% [1][2][3][4]. The two most frequent complications of pancreaticoduodenectomy are delayed gastric emptying and pancreatic fistula.…”