title: Correlation analysis between post-pancreatoduodenectomy pancreatic fistula and pancreatic histology.
abstract: OBJECTIVE
  To evaluate the relationship between the occurrence of pancreatic fistula after pancreatojejunal anastomosis in patients undergoing pancreaticoduodenectomy for periampullary malignancy and the histological fibrosis and inflammation found in pancreatic tissue and the caliber of the main pancreatic duct.
  
  
  METHODS
  We conducted a retrospective study with patients that were treated with surgical resection. The rate of pancreatic fistulae was recorded. Histology classification was performed according to fibrosis and pancreatic inflammation.
  
  
  RESULTS
  We identified 77 patients, mean age was 57.6 years; 62.4% were male. As for the type of operation performed, 66.3% were gastroduodenopancreatectomies and 33.7% pancreatoduodenectomies with pylorus preservation. Regarding the number of fistulas diagnosed, it was found that 23.4% patients displayed this postoperative complication and in 66.7% the cause was cancer of the papilla. As for intraoperative macroscopic findings, we identified the classification of pancreatic texture, seen as normal in 85.8%, and the caliber of the main pancreatic duct, finding an average of 4.9 mm. There was a significant relationship between the hardened pancreatic stump and the absence of fistula. In patients with normal or soft tissue, the rate of fistula was 25.4%. Regarding ductal diameter, we identified a higher number of pancreatic anastomotic dehiscences in the absence of ductal dilation (p <0.05). We noticed that patients with an average ductal diameter of 5.4 mm (76.7%) did not show this complication.
  
  
  CONCLUSIONS
  The presence of fibrosis and ductal dilation usually coexist and is related to a lower percentage of pancreatic fistulae.
authors.affiliation: Faculty of Medical Sciences of Santa Casa de São Paulo, Brazil. fernando@cirurgiadigestiva.med.br
authors.forename: Fernando Leal
authors.initials: FL
authors.lastname: Pereira
authors.forename: Fernando Torres
authors.initials: FT
authors.lastname: Vasques
authors.forename: André de
authors.initials: Ad
authors.lastname: Moricz
authors.forename: Tércio de
authors.initials: Td
authors.lastname: Campos
authors.forename: Adhemar Monteiro
authors.initials: AM
authors.lastname: Pacheco
authors.forename: Rodrigo Altenfelder
authors.initials: RA
authors.lastname: Silva
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D012189:Retrospective Studies