The outcome of pancreatic fistulas developed after surgery for pancreatic pseudocysts.
Pancreatic fistulas (PF) develop in about 20% of cases operated for pancreatic pseudocysts. The authors analyse 81 cases of postoperative PF. These were formed following 991 operations performed for pancreatic pseudocysts (PPCs) in 850 patients from 1987 to 1992. It is concluded that the incidence of PF formation is significantly (P < 0.01) increased following interventions for acute-type pseudocysts and after external drainage. One-third of the fistulas closed spontaneously within 1-4 weeks, while another 1/3 persisted for 1-6 months before gradual closure. Closure of fistulas was facilitated by inhibition of pancreatic secretion with Somatostatin or endoscopic intervention (EST, endoprosthesis) in 24% of all cases. Only 15% (14 cases), of the fistulas, i.e. 1% of total patients, required surgery. The procedure of choice in the 14 cases was exstirpation of fistulas alone (2 cases) or combined with necrectomy (10 cases), or with distal pancreatic resection (2 cases). In cases of drained pancreatic fistulas observation can be an appropriate treatment option, while long-standing fistulas producing large amounts require intervention.
Magyar
A
A
First Department of Surgery, Semmelweis University Medical School, Budapest, Hungary.
Pulay
I
I
Bursics
A
A
Flautner
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000601:surgery*; D010189:Pancreatic Juice / Q000378:metabolism; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation