Preoperative radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy

Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.

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Pancreaticodigestive anastomosis and the postoperative management strategies to prevent postoperative pancreatic fistula formation after pancreaticoduodenectomy

Surgery Today ◽

10.1007/s00595-013-0662-x ◽

2013 ◽

Vol 44 (7) ◽

pp. 1207-1213 ◽

Cited By ~ 15

Author(s):

Daisuke Hashimoto ◽

Akira Chikamoto ◽

Masaki Ohmuraya ◽

Masahiko Hirota ◽

Hideo Baba

Keyword(s):

Pancreatic Fistula ◽

Management Strategies ◽

Postoperative Management ◽

Postoperative Pancreatic Fistula ◽

Fistula Formation

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Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

Surgery Research and Practice ◽

10.1155/2019/4940508 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Amyna Jiwani ◽

Tabish Chawla

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Surgical Techniques ◽

Multivisceral Resection ◽

Postoperative Pancreatic Fistula ◽

The Body ◽

Fistula Formation ◽

Factors Associated

Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

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Lower phosphate levels following pancreatectomy is associated with postoperative pancreatic fistula formation

HPB ◽

10.1016/j.hpb.2018.10.017 ◽

2019 ◽

Vol 21 (7) ◽

pp. 834-840 ◽

Cited By ~ 1

Author(s):

Jessica L. Mueller ◽

David C. Chang ◽

Carlos Fernandez-del Castillo ◽

Cristina R. Ferrone ◽

Andrew L. Warshaw ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Fistula Formation

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Comment on: Preoperative Sarcopenia Strongly Influences the Risk of Postoperative Pancreatic Fistula Formation After Pancreaticoduodenectomy

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-016-3293-x ◽

2016 ◽

Vol 21 (2) ◽

pp. 422-423 ◽

Cited By ~ 1

Author(s):

Umut Safer ◽

Cem Haymana ◽

Vildan Binay Safer

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Fistula Formation

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To Study the Biochemical Markers for the Prediction of Fistula Formation after Pancreatic Resection Surgery in the Post Operative Period

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.2.9 ◽

2021 ◽

Vol 3 (2) ◽

pp. 33-39

Author(s):

SA Mir ◽

S. Akhter ◽

S. S. Ahmad ◽

S. H. Altaf ◽

J. Ahmad ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Serum Amylase ◽

Postoperative Pancreatic Fistula ◽

Fistula Formation ◽

Amylase Level ◽

Medical Procedure ◽

Serum Amylase Level ◽

Post Operation ◽

Laboratory Biomarkers

Background: To study and assess the potential laboratory biomarkers for foreseeing postoperative pancreatic fistula (POPF) after pancreatic resection medical procedures. Subjects and Methods: 64 patients were studied from Jan 2008 to Dec 2018. All patients undergoing Pancreatic resection surgeries like Pancreaticoduodenectomy (PD), distal Pancreatectomy (DP) for tumors of the periampullary region, Pancreatic body or chronic pancreatitis Clinical data of the patients, surgical approach, pancreatic parenchymal tissue consistency, histopathology of the specimen, white blood cell count and blood amylase levels tube Drain fluid amylase were recorded and analyzed. Correlations between these parameters and postoperative pancreatic fistula (POPF) were assessed. Results : 22 out of the 64 (34.37%) patients developed POPF. The fistula was graded according to the ISPG classification. It was Grade An of every 10 (45.45%) patients, grade B in 8 (36.36%), and grade C in 4 (18.18%),.On univariate and multivariate strategic relapse investigations, higher amylase levels in the stomach waste liquid on a postoperative day (POD)1 and higher serum amylase levels on POD4 indicated a critical relationship with fistula arrangement in the post-operation period (POPF) (P < 0.05). On ROC (recipient working trademark bend) examination, amylase cut-off degree of 2270.67 U/L in the stomach waste liquid was related with a 76.6% affectability and 82% particularity [area under the bend (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 53.2 U/L was related with a 74.6% affectability and 72.9% explicitness (AUC: 0.784; P = 0.05). Conclusion: Post-operative channel liquid amylase levels on day 1 and serum amylase level on day 4 speak to interesting biomarkers related to POPF improvement after the pancreatic medical procedure.

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