Pancreatic fistula after pancreatic head resection; incidence, significance and management.
OBJECTIVE
Anastomotic leak at the pancreatojejunostomy remains a common and dreaded complication after pancreaticoduodenectomy. Our aim was to determine the incidence, presentation, methods of management, and preoperative and postoperative factors that influence the clinical outcome.


METHODS
We reviewed our collective experience with 70 consecutive patients from 1985 to 2000 for a variety of pathologic indications. Clinical, biochemical, intraoperative and postoperative factors were reviewed in an attempt to determine prognostic factors.


RESULTS
Nine patients (12%) developed a pancreatic anastomotic leak as determined by increased amylase in drainage fluid (70%), were clinically insignificant and were managed by simple maintenance of intraoperatively placed drains. Although octreotide was used therapeutically in 4 patients (44%), significant, objective response was noted in all patients. Of the clinical, biochemical, intraoperative and postoperative factors reviewed to determine prognostic factors, a large amount of postoperative pancreatic juice output (P = 0.02) was a significant risk factor for pancreatic fistula formation.


CONCLUSIONS
We conclude that most anastomotic leak at pancreaticoenterostomy after pancreaticoduodenectomy can be managed conservatively. Use of octreotide to aid in closure of the pancreatic leak was satisfactory.
Kinki University, School of Medicine, Department of Second Surgery, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. Hashiline@aol.com
Naoki
N
Hashimoto
Chikao
C
Yasuda
Harumasa
H
Ohyanagi
D004322:Drainage; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use; D010185:Pancreatic Fistula / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*
D005765:Gastrointestinal Agents; D015282:Octreotide