Toward defining grade C pancreatic fistula following pancreaticoduodenectomy: incidence, risk factors, management and outcome

Abstract

Grade C PF: (i) accounts for 15% of fistulae following PD and has an associated mortality rate of 35%; (ii) occurs most commonly in pathology associated with a soft remnant, and (iii) requires reoperation in approximately one half of patients. The published literature incompletely describes grade C PF.

An analysis of risk factors for pancreatic fistula after robotic pancreaticoduodenectomy: outcomes from a consecutive series of standardized pancreatic reconstructions

“…We sought to illicit the factors behind POPF after RPD in an attempt to identify whether some of these were unique to the robotic platform. In this analysis, the overall rate of POPF after RPD was 17 %, comparing favorably to most OPD series that report fistulae in the 'post-ISGPF era' [2,3,5,[10][11][12]. This rate is also in line with more recent POPF outcomes reported in large LPD series [13][14][15].…”

“…Postoperative pancreatic fistula (POPF) represents the most frequent source of morbidity after pancreaticoduodenectomy (PD) with a reported incidence of 10-26 % when classified by the International Study Group for Pancreatic Fistula (ISGPF) criteria [1][2][3][4][5]. Consequently, significant efforts have been directed at identifying risk factors of POPF after PD [6-10].…”

Systematic Review and Meta-Analysis of Somatostatin Analogues in the Prevention of Postoperative Complication after Pancreaticoduodenectomy

“…Pancreatic fistula (PF) is the leading cause of morbidity and mortality after PD [2,3]. To reduce the incidence of PF, various methods have been proposed, including either technical or pharmacologic approaches [4].…”

Diagnosis and management of postoperative pancreatic fistula

“…b A pig-tail drain is placed into the collection employing the Seldinger technique failure of non-operative management, and the risk of dying within 5 years after PD was six times greater in patients with POPF in whom non-operative management failed [38]. The choice of the technique is often dictated by intraoperative findings, while the severity of clinical instability will also set limitations regarding extent and duration of the operative procedure [36,39,40]. Access to the complication site can be a fortuitous trial, because the operating field is hindered by significant inflammation from local sepsis and tissue degradation [41].…”