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News

Management of outcomes of postpancreatectomy fistula

This week’s issue of the Journal of the American College of Surgeons reports on the management and outcomes of postpancreatectomy fistula, leak, and abscess.

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Anastomotic fistula, leak, and abscess are common complications of pancreatectomy.

Dr Yael Vin and colleagues from the USA described their current management and outcomes of clinically significant postpancreatectomy fistula, leak, and abscess.

Review of a prospectively maintained database identified 908 patients who underwent pancreatectomy between 2000 and 2005.

The team entered complication data into a validated postoperative complication database.

Patients were included if they were identified as having a clinically significant pancreatic fistula, leak, or abscess.

Multivariate analyses were performed to identify factors predictive of prolonged drainage.

The researchers found that clinically significant postoperative fistula, leak, or abscess occurred in 17% of resected patients.

The research team evaluated 63 culture-positive pancreatic fistulas, 29 noninfected pancreatic fistulas, 42 abscesses, and 24 other collections.

Surgical drains were placed at the time of initial resection in 56% of patients.

Adequate drainage was obtained by prolonged use of surgical drains in 18%
Journal of the American College of Surgeons

Adequate drainage was obtained by prolonged use of surgical drains in 18% of patients.

Reoperation was required in 16% of patients.

Intensive care unit admission was required in 22%.

Within the group of 158 patients, the mortality rate was 5%.

At the time of discharge a home health aide was required in 56% of patients, 8% were discharged to a rehabilitation facility, and readmission was required in 50% of patients.

Mean drainage time was 38 days.

Predictors of prolonged drainage included drain output over 200 mL during the first 48 hours and distal pancreatectomy.

Dr Vin’s concluded, “Although mortality after pancreatectomy has decreased to approximately 2%, the morbidity associated with pancreatic fistula, leak, and abscess remains substantial.”

J Am Coll Surg 2008: 207(4): 490-8


06 October 2008

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