Dr Gregory Veillette and colleagues from Boston, USA described the management and impact of pancreatic fistulas in a high-volume center.
The team assessed 581 consecutive patients who underwent pancreaticoduodenectomy from 2001 through 2006.
Development of a pancreatic fistula was defined as more than 30 mL of amylase-rich fluid from drains on or after postoperative day 7 or discharge with surgical drains in place, regardless of amount.
|The overall fistula-related mortality was 9%|
|Archives of Surgery|
The need for additional interventions or total parenteral nutrition, other morbidity, and mortality were recorded.
The researchers identified 75 patients who developed a pancreatic fistula.Fistulas were managed with gradual withdrawal of surgical drains.
This allowed for patient discharge and eventual closure at a mean of 18 days in 39% of cases.
These were classified as low-impact fistulas.
The remaining 61% of patients had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding.
These were classified as high-impact fistulas, and closed a mean of 35 days after surgery.
Standard 30-day in-hospital mortality was 2% for all pancreaticoduodenectomies, and 7% for those who developed a pancreatic fistula.
The overall fistula-related mortality was 9%, all but 1 of which was related to major hemorrhage.
Dr Veillette's team concludes, "More than 33% of pancreatic fistulas are clinically insignificant."
"The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality."