Postoperative pancreatic fistulas: preventing severe complications and reducing reoperation and mortality rate.
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.
Pedrazzoli
Sergio
S
Clinica Chirurgica IV, University of Padova, General Hospital, Castelfranco Veneto (Treviso), Italy. sergio.pedrazzoli@unipd.it
Liessi
Guido
G
Pasquali
Claudio
C
Ragazzi
Roberto
R
Berselli
Mattia
M
Sperti
Cosimo
C
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