title: Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy: a comparison of different surgical strategies.
abstract: BACKGROUND
  A relaparotomy for a pancreatic fistula (PF) after a pancreaticoduodenectomy (PD) is a formidable operation, and the appropriate treatment of anastomotic leakage is under debate. The objective of this study was to compare the outcomes of different strategies in managing the pancreatic remnant during a relaparotomy for PF after a PD.
  
  
  METHODS
  In this retrospective study on prospectively collected data, 669 PD were performed between 2004 and 2011. The study group comprised 31 patients requiring a relaparotomy, because of delayed haemorrhage (n = 19) or sepsis (n = 12). The pancreatic stump was treated either using pancreas-preserving techniques (simple drainage or duct occlusion) or completion of a pancreatectomy (CP). In 2008, autologous islet transplantation (AIT) was introduced for endocrine tissue rescue of CP.
  
  
  RESULTS
  The mortality rate, blood loss and transfusion requirement were similar for all techniques. Patients undergoing a CP required a further relaparotomy less frequently than patients with pancreas preservation (7% versus 59%, P < 0.01), and the intensive care unit (ICU) stay was reduced after CP (P = 0.058). PF persisted at discharge in 66% of patients after pancreas-preserving techniques. AIT was associated with CP in 7 patients, of whom one died post-operatively. Long-term graft function was maintained in four out of six surviving patients, with one insulin-independent patient at 36 months after transplantation.
  
  
  CONCLUSIONS
  When a PF requires a relaparotomy, CP has become our favoured technique. AIT can reduce the metabolic impact of the procedure.
authors: Pancreatic Surgery Unit, Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors: Gianpaolo
authors: G
authors: Balzano
authors: Nicolò
authors: N
authors: Pecorelli
authors: Lorenzo
authors: L
authors: Piemonti
authors: Riccardo
authors: R
authors: Ariotti
authors: Michele
authors: M
authors: Carvello
authors: Rita
authors: R
authors: Nano
authors: Marco
authors: M
authors: Braga
authors: Carlo
authors: C
authors: Staudacher
mesh_terms: D000368:Aged; D004322:Drainage / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome