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Pancreatic Fistulas after Pancreaticoduodenectomy or Distal Pancreatectomy

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Surgical Treatment of Pancreatic Diseases

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Pancreatic fistula is defined as an abnormal communication between the pancreatic ductal system and any other space, internal or external to the peritoneal cavity, caused by an interruption to the integrity of the ductal epithelium itself [1]. Pancreatic fistulas are thus divided into internal and external, the former being by far the most frequent and almost the only ones that occur after pancreatic resection. In fact, whenever a postoperative fistula develops, in the absence of adequate drainage the result will be an abdominal collection that evolves into an abscess or a pseudocyst rather than an internal fistula.

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References

  1. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  2. Conlon KC, Labow D, Leung D et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493; discussion 493–494

    Article  CAS  PubMed  Google Scholar 

  3. Molinari E, Bassi C, Salvia R et al (2007) Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula. Results of a prospective study in 137patients. Ann Surg 246:281–287

    Article  PubMed  Google Scholar 

  4. Pederzoli P, Bassi C, Falconi M et al (1994) Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Br J Surg 81:265–269

    Article  CAS  PubMed  Google Scholar 

  5. Buchler M, Frieb H, Klempa I et al (1992) The role of somatostatin analogue octreotide in the prevention of postoperative complications following pancreatic resection. The results of a multicentre controlled trial. Am J Surg 163:125–131

    Article  CAS  PubMed  Google Scholar 

  6. Buchler MW, Friess H, Wagner M et al (2000) Pancreatic fistula after pancreatic head resection. Br J Surg 87:883–889

    Article  CAS  PubMed  Google Scholar 

  7. Bassi C, Butturini G, Molinari E et al (2004) Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 21:54–59

    Article  PubMed  Google Scholar 

  8. Lermite E, Pessaux P, Brehant O et al (2007) Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 204:588–596

    Article  PubMed  Google Scholar 

  9. Pratt W, Maithel SK, Vanounou T et al (2006) Postoperative pancreatic fistulas are not equivalent after proximal, distal, and central pancreatectomy. J Gastrointest Surg 10:1264–1278; discussion 1278–1279

    Article  PubMed  Google Scholar 

  10. Iannitti DA, Coburn NG, Somberg J et al (2006) Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique. J Am Coll Surg 203:857–864

    Article  PubMed  Google Scholar 

  11. Aranha GV, Aaron JM, Shoup M et al (2006) Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery 140:561–568; discussion 568–569

    Article  PubMed  Google Scholar 

  12. Lin JW, Cameron JL, Yeo CJ et al (2004) Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 8:951–959

    Article  PubMed  Google Scholar 

  13. Muscari F, Suc B, Kirzin S et al (2006) Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery 139:591–598

    Article  PubMed  Google Scholar 

  14. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937; discussion 937–939

    Article  PubMed  Google Scholar 

  15. Sierzega M, Niekowal B, Kulig J et al (2007) Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg 205:52–59

    Article  PubMed  Google Scholar 

  16. Moon HJ, Heo JS, Choi SH et al (2005) The efficacy of the prophylactic use of octreotide after a pancreaticoduodenectomy. Yonsei Med J 46:788–793

    Article  CAS  PubMed  Google Scholar 

  17. Connor S, Alexakis N, Garden OJ et al (2005) Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg 92:1059–1067

    Article  CAS  PubMed  Google Scholar 

  18. Büchler MW, Binder M, Friess H (1994) Role of somatostatin and its analogues in the treatment of acute and chronic pancreatitis. Gut 35(3 Suppl):S15–S19

    Article  PubMed  Google Scholar 

  19. Takeuchi K, Tsuzuki Y, Ando T et al (2003) Distal pancreatectomy: is staple closure beneficial? ANZ J Surg 73:922–925

    Article  PubMed  Google Scholar 

  20. Bassi C, Falconi M, Molinari E et al (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242:767–771, discussion 771–773

    Article  PubMed  Google Scholar 

  21. Bassi C, Butturini G, Salvia R et al (2006) Open pancreaticogastrostomy after pancreaticoduodenectomy: a pilot study. J Gastrointest Surg 10:1072–1080

    Article  PubMed  Google Scholar 

  22. Kawai M, Tani M, Terasawa H et al (2006) Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 244:1–7

    Article  PubMed  Google Scholar 

  23. Payne RF, Pain JA (2006) Duct-to-mucosa pancreaticogastrostomy is a safe anastomosis following pancreaticoduodenectomy. Br J Surg 93:73–77

    Article  CAS  PubMed  Google Scholar 

  24. Munoz-Bongrand N, Sauvanet A, Denys A et al (2004) Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 199:198–203

    Article  PubMed  Google Scholar 

  25. Bassi C, Butturini G, Falconi M et al (1999) Prospective randomised pilot study of management of the pancreatic stump following distal resection. HPB 1:203–207

    Google Scholar 

  26. Brennan M, Moccia RD, Klimstra D (1996) Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 223:506–512

    Article  CAS  PubMed  Google Scholar 

  27. Fabre JM, Houre S, Manderscheid JC et al (1996) Surgery for the left-sided pancreatic cancer. Br J Surg 83:1065–1070

    Article  CAS  PubMed  Google Scholar 

  28. Kuroki T, Tajima Y, Kanematsu T (2005) Surgical management for the prevention of pancreatic fistula following distal pancreatectomy. J Hepatobiliary Pancreat Surg 12:283–285

    Article  PubMed  Google Scholar 

  29. Pannegeon V, Pessaux P, Sauvanet A et al (2006) Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 141:1071–1076; discussion 1076

    Article  PubMed  Google Scholar 

  30. Knaebel HP, Diener MK, Wente MN et al (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546

    Article  CAS  PubMed  Google Scholar 

  31. Fahy BN, Frey CF, Ho HS et al (2002) Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 183:237–241

    Article  PubMed  Google Scholar 

  32. Sheehan MK, Beck K, Creech S et al (2002) Distal pancreatectomy: does the method of closure influence fistula formation? Am Surg 68:264–267

    PubMed  Google Scholar 

  33. Bilimoria MM, Cormier JN, Mun Y et al (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196

    Article  CAS  PubMed  Google Scholar 

  34. Adam U, Makowiec F, Riediger H et al (2001) Distal pancreatic resection-indications, techniques and complications. Zentralbl Chir 126:908–912

    Article  CAS  PubMed  Google Scholar 

  35. Suzuki Y, Fujino Y, Tanioka Y et al (1999) Randomised clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 86:608–611

    Article  CAS  PubMed  Google Scholar 

  36. Ohwada S, Ogawa T, Tanahashi Y et al (1998) Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg 22:494–498

    Article  CAS  PubMed  Google Scholar 

  37. Di Francesco V, Angelini G, Bovo P et al (1996) Effect of octreotide on sphincter of Oddi motility in patients with acute recurrent pancreatitis: a manometric study. Dig Dis Sci 41:2392–2396

    Article  PubMed  Google Scholar 

  38. Buscail L, Faure P, Bournet B et al (2006) Interventional endoscopic ultrasound in pancreatic diseases. Pancreatology 6(1–2):7–16

    Article  PubMed  Google Scholar 

  39. Baron TH (2003) Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis. Gastrointest Endosc Clin N Am 13:743–764

    Article  PubMed  Google Scholar 

  40. Papachristou GI, Takahashi N, Chahal P et al (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245:943–951

    Article  PubMed  Google Scholar 

  41. Kahaleh M, Shami VM, Conaway MR et al (2006) Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 38:355–359

    Article  CAS  PubMed  Google Scholar 

  42. Giovannini M, Pesenti C, Rolland AL et al (2001) Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope. Endoscopy 33:473–477

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Endocrine and Pancreatic Unit, Department of Gastroenterology and Surgery, G.B. Rossi Hospital, University of Verona, Italy

    Giovanni Butturini, Despoina Daskalaki, Claudio Bassi & Paolo Pederzoli

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  1. Giovanni Butturini
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  2. Despoina Daskalaki
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  3. Claudio Bassi
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  4. Paolo Pederzoli
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© 2009 Springer-Verlag Italia

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Butturini, G., Daskalaki, D., Bassi, C., Pederzoli, P. (2009). Pancreatic Fistulas after Pancreaticoduodenectomy or Distal Pancreatectomy. In: Surgical Treatment of Pancreatic Diseases. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-0856-4_30

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  • DOI: https://doi.org/10.1007/978-88-470-0856-4_30

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0855-7

  • Online ISBN: 978-88-470-0856-4

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