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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 14, 2008; 14(38): 5789-5796
Published online Oct 14, 2008. doi: 10.3748/wjg.14.5789
Pancreatic fistula after pancreatectomy: Evolving definitions, preventive strategies and modern management
Shailesh V Shrikhande, Melroy A D’Souza
Shailesh V Shrikhande, Melroy A D’Souza, Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai 400-012, India
Author contributions: Shrikhande SV conceptualised the paper, provided important intellectual contributions and modified the manuscript; D’Souza MA wrote the paper and provided intellectual contributions.
Correspondence to: Shailesh V Shrikhande, MS, MD, Associate Professor and Consultant Surgeon, Department of GI and HPB Surgical Oncology, Ernest Borges Marg, Parel, Mumbai 400-012, India. shailushrikhande@hotmail.com
Telephone: + 91-22-24144489 Fax: + 91-22-24148114
Received: June 11, 2008
Revised: July 28, 2008
Accepted: August 4, 2008
Published online: October 14, 2008
Abstract

Pancreatic resection is the treatment of choice for pancreatic malignancy and certain benign pancreatic disorders. However, pancreatic resection is technically a demanding procedure and whereas mortality after a pancreaticoduodenectomy is currently < 3%-5% in experienced high-volume centers, post-operative morbidity is considerable, about 30%-50%. At present, the single most significant cause of morbidity and mortality after pancreatectomy is the development of pancreatic leakage and fistula (PF). The occurrence of a PF increases the length of hospital stay and the cost of treatment, requires additional investigations and procedures, and can result in life-threatening complications. There is no universally accepted definition of PF that would allow standardized reporting and proper comparison of outcomes between different centers. However, early recognition of a PF and prompt institution of appropriate treatment is critical to the prevention of potentially devastating consequences. The present article, reviews the evolution of post resection pancreatic fistula as a concept, and discusses evolving definitions, the current preventive strategies and the management of this problem.

Keywords: Pancreatic fistula; Pancreaticoduodenectomy; Pancreatic anastomosis; Pancreatic anastomotic failure; Complications