title: [External pancreatic fistulas management].
abstract: The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Surgical formation of anastomosis between distal part of the main pancreatic duct and gastro-intestinal tract was carried out when it was impossible to fulfill endoscopic stenting of pancreatic duct either because of its interruption and diastasis between its ends, or in the cases of unsuccessful conservative treatment of external pancreatic fistula caused by drainage of pseudocyst.
authors.affiliation: Sklifosovsky Research Institute of Emergency Care, Moscow.
authors.forename: E V
authors.initials: EV
authors.lastname: Stepan
authors.affiliation: Sklifosovsky Research Institute of Emergency Care, Moscow.
authors.forename: A S
authors.initials: AS
authors.lastname: Ermolov
authors.affiliation: Sklifosovsky Research Institute of Emergency Care, Moscow.
authors.forename: M L
authors.initials: ML
authors.lastname: Rogal'
authors.affiliation: Sklifosovsky Research Institute of Emergency Care, Moscow.
authors.forename: Yu S
authors.initials: YS
authors.lastname: Teterin
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000072700:Conservative Treatment / Q000379:methods; D004386:Duodenum / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods; D015607:Stents