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Non-operative management of pancreatic fistulas

Pancreatic fistulas after pancreaticduodenectomy do not affect mortality rate, and can be managed nonoperatively without prolonging hospital stay, finds this month's issue of Archives of Surgery.

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Pancreatic fistula, a common and potentially lethal complication of pancreaticoduodenectomy.

Dr Kevork Kazanjian and colleagues investigated whether pancreatic fistula can be managed nonoperatively in most cases.

The research team retrospectively studied cases in a major academic medical and pancreatic surgery center.

The team included a total of 437 consecutive patients who underwent pancreaticoduodenectomy for various diagnoses between 1988 and 2004.

Pancreatic fistula were managed conservatively with an intraoperatively placed closed-suction drain near the pancreaticojejunostomy anastomosis.

Pancreatic fistula were successfully managed in 52 with prolonged tube drainage
Archives of Surgery

The researchers also conducted computed tomography-guided percutaneous drainage, and surgery.

Main outcome measures included the incidence of pancreatic fistula after pancreaticoduodenectomy and patient outcomes.

The team found that 55 patients developed a pancreatic fistula, which was most common after resections for ampullary tumors and cystic neoplasms.

The team also found that pancreatic fistula were uncommon after resection for pancreatic cancer.

The mean number of complications was greater in the pancreatic fistula group, but these did not prolong hospital stay.

The researchers observed that biliary fistula, sepsis, reoperation, and late biliary stricture were more common in patients with pancreatic fistula.

Mortality rate and long-term survival in patients with either pancreatic or ampullary cancer were unaffected by the presence of pancreatic fistula.

The team noted that 52 patients had successful conservative management of their pancreatic fistula with prolonged tube drainage.

The researchers observed that 4 also required computed tomography-guided percutaneous drainage.

In addition, the team reported that 3 patients underwent reoperation and 1 died.

Dr Kazanjian's team concludes, “Pancreatic fistula is a common problem after pancreaticoduodenectomy.”

“It is associated with increased morbidity, but it does not affect the mortality rate.”

“More than 90% of pancreatic fistula cases can be managed nonoperatively without significantly prolonging hospital stay.”

Arch Surg 2005: 140(9): 849-855
21 September 2005

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