Postoperative pancreatic fistula (POPF) is a common complication of pancreatic resection. Aim of this study is to identify variables related to the development of POPF, analyze their clinical significance and discuss our current approach to the pancreatico-jejunal anastomosis. A series of 129 patients undergoing pancreatico-duodenectomy (PD) have been analyzed. Patients were divided in two groups: group F, 26 patients who have developed POPF; group NF, 103 patients who have not developed POPF. Demographic, clinical and intraoperative data were compared. Seventy-six patients had an end-to-side (ES) pancreatico-jejuno anastomosis, 53 an end-to-end (EE) anastomosis. Fifteen patients developed grade A fistulas, seven grade B, and four grade C; two patients with grade C fistula died from septic shock. Preoperative bile duct lithiasis, diameter of the pancreatic duct and consistency of the pancreatic stump were significantly different between F and NF groups at multivariate analysis. POPF has been related to clinical and biological parameters: preoperative bile duct lithiasis and challenging pancreatico-jejunal anastomosis (with small pancreatic duct and friable pancreatic stump) are the most prominent according to our experience. As the incidence of POPF seems to be related to technically demanding surgery, we presently reserve the EE anastomosis to the cases in which a friable gland or a very small duct will make a direct anastomosis on the pancreatic duct unreliable. In case of grade C fistulas a total spleen-preserving pancreatectomy should be considered an adequate treatment to prevent the onset of a multi-organ failure or a septic shock if no other treatment seems suitable. © 2014 Springer-Verlag Italia

DE CARLIS, L., Ferla, F., Di Sandro, S., Giacomoni, A., De Carlis, R., Sguinzi, R. (2014). Pancreatico-duodenectomy and postoperative pancreatic fistula: Risk factors and technical considerations in a specialized HPB center. UPDATES IN SURGERY, 66(2), 145-150 [10.1007/s13304-014-0253-4].

Pancreatico-duodenectomy and postoperative pancreatic fistula: Risk factors and technical considerations in a specialized HPB center

DE CARLIS, LUCIANO GREGORIO
Primo
;
2014

Abstract

Postoperative pancreatic fistula (POPF) is a common complication of pancreatic resection. Aim of this study is to identify variables related to the development of POPF, analyze their clinical significance and discuss our current approach to the pancreatico-jejunal anastomosis. A series of 129 patients undergoing pancreatico-duodenectomy (PD) have been analyzed. Patients were divided in two groups: group F, 26 patients who have developed POPF; group NF, 103 patients who have not developed POPF. Demographic, clinical and intraoperative data were compared. Seventy-six patients had an end-to-side (ES) pancreatico-jejuno anastomosis, 53 an end-to-end (EE) anastomosis. Fifteen patients developed grade A fistulas, seven grade B, and four grade C; two patients with grade C fistula died from septic shock. Preoperative bile duct lithiasis, diameter of the pancreatic duct and consistency of the pancreatic stump were significantly different between F and NF groups at multivariate analysis. POPF has been related to clinical and biological parameters: preoperative bile duct lithiasis and challenging pancreatico-jejunal anastomosis (with small pancreatic duct and friable pancreatic stump) are the most prominent according to our experience. As the incidence of POPF seems to be related to technically demanding surgery, we presently reserve the EE anastomosis to the cases in which a friable gland or a very small duct will make a direct anastomosis on the pancreatic duct unreliable. In case of grade C fistulas a total spleen-preserving pancreatectomy should be considered an adequate treatment to prevent the onset of a multi-organ failure or a septic shock if no other treatment seems suitable. © 2014 Springer-Verlag Italia
Articolo in rivista - Articolo scientifico
Pancreas surgery; Pancreatic anastomosis; Pancreatic anastomotic failure; Pancreatic fistula; Pancreatico-duodenectomy; Surgery complications; Adult; Aged; Aged, 80 and over; Female; Health Facilities; Humans; Male; Middle Aged; Pancreatic Fistula; Pancreaticoduodenectomy; Retrospective Studies; Risk Factors; Time Factors; Surgery
English
2014
66
2
145
150
none
DE CARLIS, L., Ferla, F., Di Sandro, S., Giacomoni, A., De Carlis, R., Sguinzi, R. (2014). Pancreatico-duodenectomy and postoperative pancreatic fistula: Risk factors and technical considerations in a specialized HPB center. UPDATES IN SURGERY, 66(2), 145-150 [10.1007/s13304-014-0253-4].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/101005
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