Defining, Controlling, and Treating a Pancreatic Fistula

Excerpt

The Achilles heel of pancreatic surgery is the pancreas. After resection of the pancreatic head, the residual pancreas must be drained into the gastrointestinal tract. This connection is among the most tenuous in surgery. Hundreds if not thousands of publications have been devoted to pancreatic surgical technique based on the hope that some technical innovation will prevent this complication. To summarize this vast literature: as long as an experienced pancreatic surgeon performs the procedure, no method of anastomosis is less likely to result in a pancreatic leak than another. This review will focus on complications of pancreatoduodenectomy. The treatment of a postoperative leak or fistula after distal pancreatectomy is less of a clinical issue but can be diagnosed and treated using similar methods. The diagnosis of a leak will first be defined and then the treatment of both an acute leak and a chronic controlled fistula will be discussed. The difference between a leak and a fistula is control and chronicity. When a leak is controlled and persists, it becomes a fistula. Though leak and fistula are different aspects of the same disease process, the treatment of an acute leak is very different than the treatment of a chronic fistula. …