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World J Gastroenterol. Oct 14, 2007; 13(38): 5096-5100
Published online Oct 14, 2007. doi: 10.3748/wjg.v13.i38.5096
Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?
Marco Pericoli Ridolfini, Sergio Alfieri, Stavros Gourgiotis, Dario Di Miceli, Fabio Rotondi, Giuseppe Quero, Roberta Manghi, Giovanni Battista Doglietto
Marco Pericoli Ridolfini, Sergio Alfieri, Dario Di Miceli, Fabio Rotondi, Giuseppe Quero, Roberta Manghi, Giovanni Battista Doglietto, Department of Surgical Sciences, Gemelli University Hospital, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
Stavros Gourgiotis, Hepatobiliary and Pancreatic Surgery Department, Royal London Hospital, London, United Kingdom
Author contributions: All authors contributed equally to the work.
Correspondence to: Sergio Alfieri, MD, Department of Digestive Surgery, Catholic University, L.go Agostino Gemelli 8, Rome 00168, Italy. s.alfieri@rm.unicatt.it
Telephone: +39-6-30155133 Fax: +39-6-30155133
Received: March 26, 2007
Revised: June 26, 2007
Accepted: July 5, 2007
Published online: October 14, 2007
Abstract

AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump.

METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined.

RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy(n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear.

CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

Keywords: Pancreas; Distal pancreatectomy; Pancreatic fistula