title: Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients.
abstract: OBJECTIVE
  Pancreatic fistula (PF), a common and potentially lethal complication of pancreaticoduodenectomy, can be managed nonoperatively in most cases.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Major academic medical and pancreatic surgery center.
  
  
  METHODS
  A total of 437 consecutive patients who underwent pancreaticoduodenectomy for various diagnoses between January 1, 1988, and August 31, 2004.
  
  
  METHODS
  Conservative management of PF with an intraoperatively placed closed-suction drain near the pancreaticojejunostomy anastomosis, computed tomography-guided percutaneous drainage, and surgery.
  
  
  METHODS
  Incidence of PF after pancreaticoduodenectomy and patient outcomes.
  
  
  RESULTS
  Fifty-five patients (12.6%) developed a PF, which was most common after resections for ampullary tumors (21.1%) and cystic neoplasms (31.3%), and uncommon after resection for pancreatic cancer (6.5%). The mean number of complications (excluding PF) was greater in the PF group (PF, 1.24; no PF, 0.54; P<.001), but these did not prolong hospital stay (PF, 15.2 days; no PF, 13.7 days; P = .20). Biliary fistula, sepsis, reoperation, and late biliary stricture were more common in patients with PF (P<.05), but mortality rate and long-term survival in patients with either pancreatic or ampullary cancer were unaffected by the presence of PF (P>.40). Fifty-two patients (94.5%) had successful conservative management of their PF with prolonged tube drainage; 4 also required CT-guided percutaneous drainage. Three patients (5.5%) underwent reoperation and 1 died.
  
  
  CONCLUSIONS
  Pancreatic fistula is a common problem after pancreaticoduodenectomy. It is associated with increased morbidity, but it does not affect the mortality rate. More than 90% of PF cases can be managed nonoperatively without significantly prolonging hospital stay.
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, 90095-6904, USA.
authors.forename: Kevork K
authors.initials: KK
authors.lastname: Kazanjian
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Hines
authors.forename: Guido
authors.initials: G
authors.lastname: Eibl
authors.forename: Howard A
authors.initials: HA
authors.lastname: Reber
mesh_terms: D000368:Aged; D004066:Digestive System Diseases / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis