Clinical and Economic Validation of the International Study Group of Pancreatic Fistula (ISGPF) Classification Scheme

Pancreatic fistula (PF) continues to be the Achilles’ heel of pancreaticoduodenectomy (PD) with both morbidity and mortality linked to its occurrence. The optimal drain management strategy after PD remains unclear. We evaluated drain amylase (DA) levels on postoperative Day (POD) 0 to 5 in 76 consecutive patients undergoing PD to determine the patterns associated with PF. Of these 76 patients, eight patients (11%) developed Grade A, B, or C PF by International Study Group of Pancreatic Fistula criteria. POD 1 DA levels correlated closely with PF rates when high (greater than 5000 U/L, 100% PF rate) and low (less than 100 U/L, 2% PF rate). In patients with intermediate POD 1 DA (100 to 5000 U/L), 42 and 74 per cent had low DA levels on POD 3 and 5, respectively, and the PF rate was four of 31 (13%). Overall, the temporal pattern of decreasing DA levels after PD correlates closely with the risk of PF, and only two patients (5%) developed PF after early DA levels had normalized. Based on these data, we propose an algorithm of monitoring DA daily with drain removal when the level is less than 100 U/L. In our patient group drain removal would have occurred on a mean of 1.8 days and median 1 day after surgery.

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Use and acceptance of the international study group for pancreatic fistula (ISGPF) criteria in surgical literature

HPB ◽

10.1016/j.hpb.2017.02.143 ◽

2017 ◽

Vol 19 ◽

pp. S100

Author(s):

Brian P. Chen ◽

Sean Bennett ◽

Kimberly Bertens ◽

Richard Mimeault ◽

Fady K. Balaa ◽

...

Keyword(s):

Pancreatic Fistula ◽

International Study ◽

Study Group ◽

International Study Group

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Validation of Mucosal Sutureless Pancreatojejunostomy after Pancreatoduodenectomy

The American Surgeon ◽

10.1177/000313481408000222 ◽

2014 ◽

Vol 80 (2) ◽

pp. 149-154 ◽

Cited By ~ 1

Author(s):

Yoichi Ishizaki ◽

Jiro Yoshimoto ◽

Hiroyuki Sugo ◽

Hiroshi Imamura ◽

Seiji Kawasaki

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Postoperative Mortality ◽

International Study ◽

Study Group ◽

International Study Group ◽

Duct Diameter ◽

Pancreatic Duct Stenting ◽

Clinically Significant ◽

Low Rate

Although duct-to-mucosa pancreatojejunostomy has been considered safer than other techniques, this procedure is particularly difficult when the pancreatic duct is small. It has therefore become increasingly necessary to develop a simple mucosal sutureless pancreatojejunostomy technique to replace the conventional hand-sewing one. Two hundred fourteen patients who underwent mucosal sutureless pancreatojejunostomy were classified into two groups: those with a normal pancreatic duct diameter (less than 3 mm, n = 97) and those with a dilated pancreatic duct (3 mm or greater, n = 117). The rate of clinically significant pancreatic fistula (Grade B or C by the International Study Group on Pancreatic Fistula definition) among the patients as a whole was 8 per cent. The overall incidence of pancreatic fistula was significantly higher in the patients with a pancreatic duct diameter of less than 3 mm than in those with a pancreatic duct diameter of 3 mm or greater. However, the incidence of clinically significant pancreatic fistula did not differ between the groups (less than 3 mm, 11%; 3 mm or greater, 5%; P = 0.09). Grade C pancreatic fistula developed in one patient with a pancreatic duct diameter of less than 3 mm and in two with a pancreatic duct diameter 3 mm or greater. Although two patients required reoperation, all of the fistulas were cured and the postoperative mortality rate related to pancreatoduodenectomy was zero. Mucosal sutureless pancreatojejunostomy combined with pancreatic duct stenting is associated with a low rate of clinically significant pancreatic fistula even in patients with a small pancreatic duct diameter less than 3 mm.

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