Incidence and Management of Pancreatic and Enteric Fistulas After Surgical Management of Severe Necrotizing Pancreatitis

Tsiotos, Gregory G.; Smith, C. Daniel; Sarr, Michael G.

doi:10.1001/archsurg.1995.01430010050010

Cited by 114 publications

(95 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This includes defining the anatomy, controlling sepsis, optimising nutrition and undertaking surgical resection after failed conservative management. Although fistulae increase the morbidity, they do not appear to increase the mortality of patients with necrotising pancreatitis [32].…”

Section: Surgical Treatment Of Fistulaementioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

View full text Add to dashboard Cite

Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

show abstract

Section: Surgical Treatment Of Fistulaementioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

View full text Add to dashboard Cite

show abstract

“…The morphology and the clinical course of EPF following necrosectomy have been previously addressed by some authors [1,2,3,4]. Our aim was to study the clinical profile, course and outcome of patients with EPF following surgical or percutaneous intervention in acute severe pancreatitis with infective complications.…”

Section: Introductionmentioning

confidence: 99%

External Pancreatic Fistula as a Sequel to Management of Acute Severe Necrotizing Pancreatitis

et al. 2005

View full text Add to dashboard Cite

Background/Aims: External pancreatic fistula (EPF) is a common sequel to surgical or percutaneous intervention for infective complications of acute severe pancreatitis. The present study was aimed at studying the clinical profile, course and outcome of patients with EPF following surgical or percutaneous management of these infective complications. Methods: A retrospective analysis of clinical data of patients with EPF following intervention (surgical or percutaneous) for acute severe pancreatitis managed between January 1989 and April 2002 recorded on a prospective database was done. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) that could predict early closure of fistula was performed. Results: Of 210 patients with acute severe pancreatitis, 43 (20%) patients developed EPF (mean age 38 (range 16–78) years, M:F ratio 5:1) following intervention for infected pancreatic necrosis (n = 23) and pancreatic abscess (n = 20) and constituted the study group. The fistula output was categorized as low (<200 ml), moderate (200–500 ml) and high (>500 ml) in 29 (67%), 11 (26%) and 3 (7%) patients, respectively. Fifteen patients (35%) had morbidity in the form of abscess (n = 5), bleeding (n = 1), pseudoaneurysm (n = 2) and fever with no other focus of infection (n = 7). Spontaneous closure of the fistula occurred in 38 (88%) patients. The average time to closure of fistula was 109 ± 26 (median 70) days. Fistula closed after intervention in 5 patients (2 after endoscopic papillotomy, 1 after fistulojejunostomy and 2 after downsizing the drains). Of the 38 patients with spontaneous closure, 9 (24%) patients developed a pseudocyst after a mean interval of 123 days of which 7 underwent surgical drainage of the cyst. Univariate analysis of various factors (etiology, imaging findings prior to intervention, fistula characteristics and management) failed to identify any factors that could predict early closure of fistula. Conclusions: EPF is a common sequel following intervention in acute severe pancreatitis. The majority of these are low output fistulae and close spontaneously with conservative management. One-fourth of patients with spontaneous closure develop a pseudocyst as a sequel, requiring surgical management.

show abstract

“…El papel del tratamiento percutáneo está por determinar, aunque publicaciones recientes aportan tasas de éxito globales del 80% (9,11). Dada su elevada mortalidad (22-29%) (12,13), la cirugía se debe reservar para casos seleccionados: hemorragia incontrolable, sepsis, peritonitis, fistulas colopancreáticas y casos refractarios a las medidas previas (8,9).…”

Section: Discussionunclassified