Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?
OBJECTIVE
To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump.


METHODS
Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined.


RESULTS
Indications for DP included primary pancreatic disease (n=38, 59%) and non-pancreatic malignancy (n=26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear.


CONCLUSIONS
The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.
Ridolfini
Marco Pericoli
MP
Department of Surgical Sciences, Gemelli University Hospital, Catholic University of the Sacred Heart School of Medicine, Rome, Italy.
Alfieri
Sergio
S
Gourgiotis
Stavros
S
Di Miceli
Dario
D
Rotondi
Fabio
F
Quero
Giuseppe
G
Manghi
Roberta
R
Doglietto
Giovanni Battista
GB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013537:Sutures / Q000009:adverse effects