Current management of pancreatic fistula after pancreaticoduodenectomy

BackgroundPancreatic fistula (PF) is a major and serious complication following pancreaticoduodenectomy (PD). The purpose of this study was to outline our management of PF after PD.MethodsA retrospective review of a prospectively collected database of 396 patients undergoing PD for various indications at Loyola University Medical Center and Hines Veterans Administration Hospital from July 1, 1990, to December 31, 2005. Patients were divided group 1 (no PF) and group 2 (PF). Each group was compared regarding preoperative, intraoperative, and postoperative outcomes.ResultsOf the patients included in the study, 65 patients (16%) developed a PF. PF was more common after PD for ampullary neoplasms (28%), duodenal neoplasms (35%), and serous cystic neoplasms (44%), and was uncommon after PD for pancreatic cancer (6%). Associated complications with PF was 51% when compared with patients with no PF (21%; P ≤ .001). Duration of hospital stay was 16 days in PF versus 9 days in no PF (≤.001). Intraoperative blood loss was greater in the PF versus no PF group (P = .01). Clinically serious postoperative complications in the PF versus no PF group were mortality (P = .03), intraabdominal abscess (P ≤ .001), wound infection (P ≤ .001), hemorrhage (P = .01), cardiac (P ≤ .001), bile leak (P ≤ .001), and reoperation (P = .02). Of the 62 surviving patients with PF, 36 (58%) were treated with maintenance of oral diet, 25 (40%) with parenteral nutrition, and 1 (1.6%) required surgery for closure of PF.ConclusionsPF is a serious complication after PD and is associated with substantial mortality and other complications. The majority of patients with PF can be managed conservatively with either maintenance of oral diet or parenteral nutrition until closure of the PF.