TY - JOUR
T1 - Pancreatic fistula following pancreaticoduodenectomy
T2 - Clinical predictors and patient outcomes
AU - Schmidt, C. Max
AU - Choi, Jennifer
AU - Powell, Emilie S.
AU - Yiannoutsos, Constantin T.
AU - Zyromski, Nicholas J.
AU - Nakeeb, Attila
AU - Pitt, Henry A.
AU - Wiebke, Eric A.
AU - Madura, James A.
AU - Lillemoe, Keith D.
PY - 2009
Y1 - 2009
N2 - Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9). Perioperative mortality of patients with PF was 0. Forty-five of 46 PF (98) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.
AB - Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9). Perioperative mortality of patients with PF was 0. Forty-five of 46 PF (98) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.
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U2 - 10.1155/2009/404520
DO - 10.1155/2009/404520
M3 - Article
C2 - 19461951
AN - SCOPUS:67650234482
SN - 0894-8569
JO - HPB Surgery
JF - HPB Surgery
M1 - 404520
ER -