Prevention and Management of Pancreatic Fistula

Callery, Mark P.; Pratt, Wande B.; Vollmer, Charles M.

doi:10.1007/s11605-008-0534-7

Cited by 116 publications

(111 citation statements)

References 54 publications

(100 reference statements)

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“…This would generate an increased risk of about 10 times compared with hardened or intermediate consistency glands. These results have been reproduced in other studies (5,9,23) . The diameter of the Wirsung duct less than 3 mm was also associated with a 22% rate of fistula, compared to 7% in ducts with a diameter greater than 3 mm (36) .…”

Section: Pancreatic Fistulasupporting

confidence: 88%

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

Fontes

Waechter

Nectoux

et al. 2014

Arq. Gastroenterol.

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-Context -Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the "Achilles' heel" of the procedure.Objective -To evaluate the post-operative 30 days morbidity and mortality rates. Methods -Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate).Results -Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusion -The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients. HEADINGS -Pancreatic neoplasms. Pancreaticoduodenectomy. Mortality.

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Section: Pancreatic Fistulasupporting

confidence: 88%

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

Fontes

Waechter

Nectoux

et al. 2014

Arq. Gastroenterol.

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“…In our cases, we used stapler routinely for dividing the pancreas however fistula developed in 2 patients. In case of fistula occurrence, up to 90% of the patients can achieve recovery with conservative approaches as in cases (22). Patients, who are refractory to medical treatment, may require radiologic drainage, and they may rarely need surgery (22).…”

Section: Resultsmentioning

confidence: 99%

“…In case of fistula occurrence, up to 90% of the patients can achieve recovery with conservative approaches as in cases (22). Patients, who are refractory to medical treatment, may require radiologic drainage, and they may rarely need surgery (22). In some studies, somatostatin analogues were claimed to prevent fistula development (22,23 (15,17,19).…”

Section: Resultsmentioning

confidence: 99%

Operative details after laparoscopic distal pancreatectomy: our experiences in a tertiary center

Çaycı¹,

Erdoğdu²,

Dilektaşlı³

et al. 2017

Acta Oncol Tur.

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ÖZET GİRİŞ ve AMAÇ:Minimal invaziv cerrahi pankreas cerrahisinde giderek artan sıklıkta kullanılmaktadır. Çalışmamızda laparoskopik distal pankreatektomi operasyon deneyimi ve erken dönem sonuçlarımızın sunulması amaçlanmıştır. YÖNTEM ve GEREÇLER: Pankreas gövde ve kuyruk yerleşimli tümoral lezyonlar nedeniyle laparoskopik distal pankreatektomi yapılan 15 hastanın verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, comorbidite, lezyon özellikleri, cerrahi sonuçlar ve uzun dönem takip sonuçları kaydedildi. BULGULAR: Laparoskopik distal pankreatektomi yapılan olguların 7'si erkek (%46,6), 8'i kadın (%53,3) idi. Olguların yaş ortalaması 60,4 ± 9,82 idi. Tümor çapı median 40,4 (30-70) mm saptandı. Ortalama çıkarılan lenf nodu 6 (2-12) saptandı. Konversiyon laparatomi 6 (%40) hastada vasküler invazyon veya hemoraji sonrasında uygulandı. Postoperatif dönemde 2 (%13,3) hastada Grade A pankreas fistülü gelişti ve takip süresince spontan kapandı. Ortalama takip süresi 22 aydı (12-36 ay). Takip döneminde duktal adenokarsinomu olan 1 (%9,09) hasta 14. Ayda uzak metastaz nedeniyle eks oldu. TARTIŞMA ve SONUÇ: Pankreas gövde ve kuyruk yerleşimli bening ve malign lezyonu olan hastalarda laparoskopik distal pankreatektomi klasik cerrahi girişimlere alternatif olabilir. Anahtar Kelimeler: Pankreas, kanser, laparoskopi, distalpankreatektomi ABSTRACT INTRODUCTION: Minimal invasive surgery is being increasing lyused in pancreas surgery. In this study, we aimed to present our laparoscopic distal pancreatectomy experience. METHODS: Data from 15 patients who underwent laparoscopic distal pancreatectomy (LDP) due to tumoral lesions of the pancreas, located in the body and tail were retrospectively evaluated. Demographic data, comorbidity, lesion characteristics, surgical out come and long term follow-up results were recorded. RESULTS: There were 7 males (46.6%) and 8 females (53.3%) with theme an age of 60.4± 9.82 in the study. Mean tumor diameter was 40.4 (30-70) mm and mean derived lymph nodes was 6 (2-12). Conversion laparotomy was necessary in 6 (40%) patients due to invasion of the adjacent vascular structures or hemorrhage. During the post-operative period, 2 patients (13.3%) developed grade A pancreas fistula and spontaneously closed during follow-up. Mean follow-up period was 22 months (12-36). Operation related mortality wasn't seen. During the follow-up period, one (6.6%) patient with ductal adenocarcinoma died due to distant metastasis at post-operative 14th month. DISCUSSION AND CONCLUSION: Laparoscopic distal pancreatectomy seems a safe alternative to open surgery in patients with benign and malignant lesions of the pancreas body and tail.

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“…The reported incidence of pancreatic fistula following pancreatico-duodenectomy is 6-14% [2,3]. However, after distal pancreatectomy, it is much lower (0.5%) [4].…”

Section: Introductionmentioning

confidence: 99%

“…Those which show resistant to healing will need interventions [1]. Surgical techniques for the treatment of intractable pancreatic fistula include percutaneous transfistulous pancreatic duct drainage (PTPD), percutaneous transfistulous pancreatojejunostomy (PTPJ), and percutaneous transfistulous pancreatic duct embolization (PTPE) [1,2]. This report is based on a non-operative therapeutic strategy, in a young male who developed a cutaneous pancreatic fistula following open drainage of a collection of pus in the pancreatic bed and splenic region.…”

Section: Introductionmentioning

confidence: 99%

Outcome of A Non Healing Pancreatico-Cutaneous Fistula, Treated with Local Tetracycline Instillation – A Case Report

Nr¹,

Sk²,

Bk³

et al. 2016

Med Case Rep

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Prevention and Management of Pancreatic Fistula

Cited by 116 publications

References 54 publications

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group

Operative details after laparoscopic distal pancreatectomy: our experiences in a tertiary center

Outcome of A Non Healing Pancreatico-Cutaneous Fistula, Treated with Local Tetracycline Instillation – A Case Report

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