Pancreatic fistula after pancreatectomy: evolving definitions, preventive strategies and modern management.
Pancreatic resection is the treatment of choice for pancreatic malignancy and certain benign pancreatic disorders. However, pancreatic resection is technically a demanding procedure and whereas mortality after a pancreaticoduodenectomy is currently < 3%-5% in experienced high-volume centers, post-operative morbidity is considerable, about 30%-50%. At present, the single most significant cause of morbidity and mortality after pancreatectomy is the development of pancreatic leakage and fistula (PF). The occurrence of a PF increases the length of hospital stay and the cost of treatment, requires additional investigations and procedures, and can result in life-threatening complications. There is no universally accepted definition of PF that would allow standardized reporting and proper comparison of outcomes between different centers. However, early recognition of a PF and prompt institution of appropriate treatment is critical to the prevention of potentially devastating consequences. The present article, reviews the evolution of post resection pancreatic fistula as a concept, and discusses evolving definitions, the current preventive strategies and the management of this problem.
Shrikhande
Shailesh-V
SV
Department of GI and HPB Surgical Oncology, Ernest Borges Marg, Mumbai 400-012, India. shailushrikhande@hotmail.com
D'Souza
Melroy-A
MA
D005774:Gastrostomy; D006801:Humans; D008026:Ligation; D010180:Pancreatectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D010183:Pancreatic Ducts / Q000601:surgery; D010185:Pancreatic Fistula / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D010193:Pancreaticojejunostomy; D012086:Reoperation; D015607:Stents; D017792:Surgical Stapling; D013536:Suture Techniques; D009626:Terminology as Topic; D016896:Treatment Outcome