[Prevention of pancreatic fistulas after surgical resection. A decade of clinical trials].
PREVENTION OF FISTULA FORMATION: Pancreatic fistulae occur in about 10-20% of patients undergoing pancreaticoduodenectomy and are a leading cause of morbidity. We reviewed trials devoted to prevention. Surgical procedures for reduction of pancreatic secretion and modification of the remnant pancreas could be useful as preventive measures.
Several surgical procedures have been proposed to decrease the rate of complications, but none have demonstrated efficacy in a prospective randomized trial. Pancreatogastrostomy (PG) or pancreatojejuneostomy (PJ) have been compared in nine studies: seven retrospective series and two prospective randomized trials. The one trial using a correct randomization method found equivalent early results for PG and PJ.
Eleven randomized trials have assessed the use of somatostatin or octreotide for the prevention of fistulae after pancreaticoduodenectomy. There has been significant heterogeneity in these trials concerning the definition of fistula, dosage of octreotide, starting time and duration of treatment. Six studies have concluded that these drugs are effective while 5 concluded that there is no significant difference.


CONCLUSIONS
There is no convincing argument to affirm the superiority of PG or PJ. For the present, the use of somatostatin or octreotide cannot be recommended in routine practice for the prevention of postoperative complications of pancreatic surgery.
Pessaux
P
P
Département de chirurgie viscérale, CHU Angers, 4 rue Larrey, F49033 Angers.
Tuech
J J
JJ
Arnaud
J P
JP
D000714:Anastomosis, Surgical / Q000379:methods; D002986:Clinical Trials as Topic; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010179:Pancreas / Q000378:metabolism / Q000601:surgery; D010185:Pancreatic Fistula / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods*; D013270:Stomach / Q000601:surgery