title: Diagnosis and management of postoperative pancreatic fistula.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is the leading complication after partial pancreatic resection and is associated with increased length of hospital stay and resource utilization. The introduction of a common definition in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), which has been since employed in the vast majority of reports, has allowed a reliable comparison of surgical results. Despite the systematic investigation of risk factors and of surgical techniques, the incidence of POPF did not change in recent years, whereas the associated mortality has decreased.
  
  
  OBJECTIVE
  The purposes of this review article were to summarize the current evidence on the diagnosis and management strategies of POPF and to provide a concise reference for the practicing surgeons and physicians.
  
  
  CONCLUSIONS
  The high incidence of POPF was accompanied by a shift from operative to non-operative management. However, the current management strategy is driven by the patient's condition and local expertise and is generally based on poor evidence. A randomized trial showed that enteral nutrition is superior to total parenteral nutrition, and pooled data of randomized trials failed to show any advantage of somatostatin analogs for accelerating fistula closure. The choice of percutaneous versus endoscopic drainage of peripancreatic collections remains arbitrary, and-when re-operation is needed-there are very few comparative data regarding local drainage with or without main pancreatic stenting as opposed to anastomotic revision or salvage re-anastomosis. The continuous development of specialist, high-volume units with appropriate resources and multidisciplinary experience in complication management might further improve the evidence and the outcomes.
authors.affiliation: Unit of Surgery B, The Pancreas Institute, Department of Surgery, G.B. Rossi Hospital, University of Verona Hospital Trust, P.Le L.A. Scuro 10, 37134, Verona, Italy, giuseppe.malleo@ospedaleuniverona.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pulvirenti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
mesh_terms: D004322:Drainage / Q000379:methods; D004750:Enteral Nutrition; D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D010288:Parenteral Nutrition; D015641:Radiography, Interventional; D013004:Somatostatin / Q000031:analogs & derivatives; D025321:Surgery, Computer-Assisted; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D013004:Somatostatin