Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy.

Details

Serval ID
serval:BIB_B66B50A878FF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy.
Journal
Journal of the American College of Surgeons
Author(s)
Munoz-Bongrand N., Sauvanet A., Denys A., Sibert A., Vilgrain V., Belghiti J.
ISSN
1072-7515
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
199
Number
2
Pages
198-203
Language
english
Notes
Publication types: Journal Article - Publication Status: ppublish
Abstract
BACKGROUND: Pancreatic fistula (PF), which is a major complication of pancreaticoduodenectomy (PD), can be treated conservatively or by reoperation. The aim of this study was to evaluate conservative management of PF, which was attempted whenever possible as a first-intention treatment in a large series of PD. STUDY DESIGN: From 1990 to 2000, 242 patients underwent PD with pancreaticogastrostomy. PF was observed in 31 (13%) and was defined by an amylase-rich surgical drainage fluid (above fivefold serum amylase) after postoperative day 5, or by presence on CT scan of a fluid collection located close to the anastomosis or containing amylase-rich fluid, or by operative findings in case of reoperation. Conservative management included total parenteral nutrition, nasogastric suction, imaging-guided percutaneous drainage of collection when necessary, and somatostatin or its analogues. RESULTS: PF was symptomatic in 20 patients (65%). Amylase level on surgical drainage fluid was elevated in 23 patients (74%). Four patients (13%), including two with hemorrhage and two with intraabdominal collection not accessible by percutaneous approach, were not considered for conservative management and underwent early reoperation. Conservative management was successful in the 27 patients (100%) in whom it was attempted, including the 10 who required percutaneous drainage. The only death (3%) occurred after massive hemorrhage complicating misdiagnosed PF. Mean hospital stay was 36 +/- 12 days (range 18 to 71) after successful conservative management. CONCLUSIONS: Conservative management of PF complicating PD is feasible and successful in above 85% of patients.
Keywords
Amylases, Gastrostomy, Hemorrhage, Humans, Length of Stay, Pancreas, Pancreatic Fistula, Pancreaticoduodenectomy, Parenteral Nutrition, Reoperation, Somatostatin, Suction
Pubmed
Web of science
Create date
11/04/2008 12:22
Last modification date
20/08/2019 15:24
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