Optimal management of peripancreatic fluid collection with postoperative pancreatic fistula after distal pancreatectomy: Significance of computed tomography values for predicting fluid infection

Peripancreatic fluid collections have been observed in most patients with postoperative pancreatic fistula after distal pancreatectomy; however, optimal management remains unclear. This study aimed to evaluate the management and outcomes of patients with postoperative pancreatic fistula and verify the significance of computed tomography values for predicting peripancreatic fluid infections after distal pancreatectomy. We retrospectively investigated 259 consecutive patients who underwent distal pancreatectomy. Grade B postoperative pancreatic fistula patients were divided into two subgroups (B-antibiotics group and B-intervention group) and outcomes were compared. Predictive factor analysis of peripancreatic fluid infection was performed. Clinically relevant postoperative pancreatic fistulas developed in 88 (34.0%) patients. The duration of hospitalization was significantly longer in the B-intervention (n = 54) group than in the B-antibiotics group (n = 31; 41 vs. 17 days, p < 0.001). Computed tomography values of the infected peripancreatic fluid collections were significantly higher than those of the non-infected peripancreatic fluid collections (26.3 vs. 16.1 Hounsfield units, respectively; p < 0.001). The outcomes of the patients with grade B postoperative pancreatic fistulas who received therapeutic antibiotics only were considerably better than those who underwent interventions. Computed tomography values may be useful in predicting peripancreatic fluid collection infection after distal pancreatectomy.

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Endoscopic Transpapillary Pancreatic Duct Stent Placement for Symptomatic Peripancreatic Fluid Collection Caused by Clinically Relevant Postoperative Pancreatic Fistula After Distal Pancreatectomy

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0000000000000694 ◽

2019 ◽

Vol 29 (4) ◽

pp. 261-266 ◽

Cited By ~ 1

Author(s):

Yusuke Watanabe ◽

Keijiro Ueda ◽

So Nakamura ◽

Sho Endo ◽

Shingo Kozono ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Stent Placement ◽

Fluid Collection ◽

Postoperative Pancreatic Fistula ◽

Pancreatic Duct Stent

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Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler

Surgery Today ◽

10.1007/s00595-012-0235-4 ◽

2012 ◽

Vol 43 (2) ◽

pp. 141-147 ◽

Cited By ~ 34

Author(s):

Keiichi Okano ◽

Minoru Oshima ◽

Keitaro Kakinoki ◽

Naoki Yamamoto ◽

Shintaro Akamoto ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Predictive Factor ◽

Postoperative Pancreatic Fistula ◽

Pancreatic Thickness

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Wrapping the pancreas with a polyglycolic acid sheet before stapling reduces the risk of fluid collection on the pancreatic stump after distal pancreatectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08387-0 ◽

2021 ◽

Author(s):

Ji Su Kim ◽

Seoung Yoon Rho ◽

Dong Min Shin ◽

Munseok Choi ◽

Chang Moo Kang ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Fluid Collection ◽

International Study ◽

Polyglycolic Acid ◽

Previous Method ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Pancreatic Stump ◽

Resection Line

Abstract Background Postoperative pancreatic fistula (POPF) and postoperative fluid collection (POFC) are common complications after distal pancreatectomy (DP). The previous method of reducing the risk of POPF was the application of a polyglycolic acid (PGA) sheet to the pancreatic stump after cutting the pancreas with a stapler (After-stapling); the new method involves wrapping the pancreatic resection line with a PGA sheet before stapling (Before-stapling). The study aimed to compare the incidence of POPF and POFC between two methods. Methods Data of patients who underwent open or laparoscopic DPs by a single surgeon from October 2010 to February 2020 in a tertiary referral hospital were retrospectively analyzed. POPF was defined according to the updated International Study Group of Pancreatic Fistula criteria. POFC was measured by postoperative computed tomography (CT). Results Altogether, 182 patients were enrolled (After-stapling group, n = 138; Before-stapling group, n = 44). Clinicopathologic and intraoperative findings between the two groups were similar. Clinically relevant POPF rates were similar between both groups (4.3% vs. 4.5%, p = 0.989). POFC was significantly lesser in the Before-stapling group on postoperative day 7 (p < 0.001). Conclusions Wrapping the pancreas with PGA sheet before stapling was a simple and effective way to reduce POFC.

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Multidisciplinary Management of Postoperative Pancreatic Fistula

Digestive Disease Interventions ◽

10.1055/s-0040-1721785 ◽

2021 ◽

Author(s):

Alexa Glencer ◽

Kim Kirkwood ◽

Adam Schwertner ◽

Cody Keller ◽

Mustafa Arain ◽

...

Keyword(s):

Interventional Radiology ◽

Pancreatic Fistula ◽

Multidisciplinary Approach ◽

Postoperative Morbidity ◽

Postoperative Pancreatic Fistula ◽

Significant Source ◽

Successful Outcome ◽

Multidisciplinary Management ◽

Economic Strain ◽

Pancreatic Fistulas

AbstractPostoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary approach by a team whose skills include abdominal imaging, specialized surgery, advanced endoscopy, and interventional radiology. Intensive resources and time are often required, which impacts both patients and their caregivers. While treatment(s) continue to improve, a primary goal of research efforts in this area is the prevention of this significant source of postoperative morbidity, mortality, and economic strain.

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