Surgical management of pure pancreatic fistulas.
This paper reports on 13 patients with pure pancreatic fistulas defined as persistent lesions originating directly from the gland tissue and not from a pancreatico-intestinal or pancreatico-gastric anastomosis. Six fistulas were external and seven internal. All external fistulas were postoperative whereas all the internal ones were due to chronic pancreatitis. Conservative treatment of 2 to 36 months duration was unsuccessful, so that all patients underwent surgery. To establish a proper surgical strategy, preoperative mapping of the fistula by endoscopic retrograde cholangiopancreaticography (ERCP), fistulography and/or computerized tomography proved of value. In eleven patients, pancreatic fistula flow was surgically redirected into the gastrointestinal tract, while the remaining two were submitted to a pancreatic left resection. There were no hospital deaths and the complication rate was low. During the follow-up time of 6 to 96 months no recurrent fistulas were seen.
Department of Surgery, University Hospital, Linköping, Sweden.
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Ihse
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J
Larsson
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E
Lindström
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010193:Pancreaticojejunostomy; D010195:Pancreatitis / Q000150:complications; D011182:Postoperative Care; D011183:Postoperative Complications / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011300:Preoperative Care; D013156:Splenectomy; D014057:Tomography, X-Ray Computed