title: Chronic pancreatitis of the pancreatic remnant is an independent risk factor for pancreatic fistula after distal pancreatectomy.
abstract: BACKGROUND
  There is an ongoing debate about the best closure technique after distal pancreatectomy (DP). The aim of the closure is to prevent the formation of a clinically relevant post-operative pancreatic fistula (POPF). Stapler technique seems to be equal compared with hand-sewn closure of the remnant. For both techniques, a fistula rate of approximately 30% has been reported.
  
  
  METHODS
  We retrospectively analyzed our DPs between 01/2000 and 12/2010. In all cases, the pancreatic duct was over sewn with a separately stitched ligation of the pancreatic duct (5*0 PDS) followed by a single-stitched hand-sewn closure of the residual pancreatic gland. The POPF was classified according to the criteria of the International Study Group for Pancreatic Fistula (ISGPF). Univariate and multivariate analyses of potential risk factors for the formation of POPF were performed. Indications for operations included cystic tumors (n = 53), neuroendocrine tumors (n = 27), adenocarcinoma (n = 22), chronic pancreatitis (n = 9), metastasis (n = 6), and others (n = 7).
  
  
  RESULTS
  During the period, we performed 124 DPs (♀ = 74, ♂ = 50). The mean age was 57.5 years (18-82). The POPF rates according to the ISGPF criteria were: no fistula, 54.8% (n = 68); grade A, 24.2% (n = 30); grade B, 19.3% (n = 24); and grade C, 1.7% (n = 2). Therefore, in 21.0% (n = 26) of the cases, a clinically relevant pancreatic fistula occurred. The mean postoperative stay was significantly higher after grade B/C fistula (26.3 days) compared with no fistula/grade A fistula (13.7 days) (p < 0.05). The uni- and multivariate analyses showed chronic pancreatitis of the pancreatic remnant to be an independent risk factor for the development of POPF (p = 0.004 OR 7.09).
  
  
  CONCLUSIONS
  By using a standardized hand-sewn closure technique of the pancreatic remnant after DP with separately stitched ligation of the pancreatic duct, a comparably low fistula rate can be achieved. Signs of chronic pancreatitis of the pancreatic remnant may represent a risk factor for the development of a pancreatic fistula after DP and therefore an anastomosis of the remnant to the intestine should be considered.
authors.affiliation: Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU, Dresden, Germany. marius.distler@uniklinikum-dresden.de.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.forename: Stephan
authors.initials: S
authors.lastname: Kersting
authors.forename: Felix
authors.initials: F
authors.lastname: Rückert
authors.forename: Peggy
authors.initials: P
authors.lastname: Kross
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Saeger
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Robert
authors.initials: R
authors.lastname: Grützmann
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D050500:Pancreatitis, Chronic / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors