title: Postoperative pancreatic fistulas: preventing severe complications and reducing reoperation and mortality rate.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is responsible for severe complications and death in patients who underwent pancreatic surgery. The reported success rate of conservative treatment is around 80%. Therefore up to 20% of patients usually need surgical treatment that can be repeated in some. Uncontrolled sepsis and massive hemorrhage are the main causes for mortality in this setting.
  
  
  METHODS
  Four hundred forty-five patients underwent surgery for pancreatic diseases (January 1993-August 2007); 70 of them developed a POPF. An early aggressive treatment based on interventional radiology was applied to all patients. The drain's track and/or percutaneous approach was used to insert catheters into the peripancreatic fluid collection/s or abscess/es. The position of catheters was verified at least once a week. Surgery was performed in case of failure of conservative approach.
  
  
  RESULTS
  Conservative treatment (approach by drain's track in 49, percutaneous in 16, mixed in 2) was successful in 67 patients. A patient under dialysis had the drains inserted during an emergency surgery for peritonitis 6 days after surgery; a second patient underwent repeated surgical debridement, and a third patient underwent a procedure on the abdominal wall to separate a POPF from a colonic fistula. No patient with diagnosed POPF died.
  
  
  CONCLUSIONS
  Early aggressive interventional radiology allowed managing conservatively 95.7% of POPF preventing severe complications and avoiding death.
authors.affiliation: Clinica Chirurgica IV, University of Padova, General Hospital, Castelfranco Veneto (Treviso), Italy. sergio.pedrazzoli@unipd.it
authors.forename: Sergio
authors.initials: S
authors.lastname: Pedrazzoli
authors.forename: Guido
authors.initials: G
authors.lastname: Liessi
authors.forename: Claudio
authors.initials: C
authors.lastname: Pasquali
authors.forename: Roberto
authors.initials: R
authors.lastname: Ragazzi
authors.forename: Mattia
authors.initials: M
authors.lastname: Berselli
authors.forename: Cosimo
authors.initials: C
authors.lastname: Sperti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index