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Journal of Gastrointestinal Surgery

Published in:

01-02-2013 | Original Article

External Tube Pancreatostomy Reduces the Risk of Mortality Associated with Completion Pancreatectomy for Symptomatic Fistulas Complicating Pancreaticoduodenectomy

Authors: Dario Ribero, Marco Amisano, Giuseppe Zimmitti, Francesco Giraldi, Alessandro Ferrero, Lorenzo Capussotti

Published in: Journal of Gastrointestinal Surgery | Issue 2/2013

Abstract

Objective

This study aimed to compare the outcome of a pancreas-preserving technique consisting in a two-step procedure (external tube pancreatostomy (ETP) after resection of dehisced anastomosis followed by late anastomosis completion) with that of completion pancreatectomy (CP) for grade C fistulas complicating pancreaticoduodenectomies (PDs).

Background data

CP is the most commonly performed operation to treat a dehisced pancreato-jejunal anastomosis associated with deteriorating clinical status or hemorrhage. However, mortality of CP is high and long-term consequences are severe.

Methods

All consecutive patients who underwent PD between 1990 and 2010 were identified. Clinicopathological data, operative details, and outcomes were analyzed.

Results

Out of 370 patients, 112 (30.2 %) developed a pancreatic fistula, which was severe (grade C) in 47 cases. Forty-two patients were treated surgically by CP (n = 23; median time following PD, 10 days), ETP (n = 9; median time following PD, 8 days) or other various procedures (n = 10). Indications for re-operation and operative time of CP and ETP (207.5′ versus 170′, respectively) were similar, while postoperative mortality was significantly higher after CP (43.5 % versus 0 %, p = 0.030). Moreover, the need for a second emergency re-operation was threefold higher after CP than after ETP (39.1 % versus 11.1 %). After a median of 88 days, seven patients completed the pancreato-jejunal anastomosis without major complications or mortality. After a median follow-up of 14 months, none of the ETP patients developed diabetes.

Conclusions

External tube pancreatostomy significantly reduces the mortality associated with emergency CP. Thus, it should always be considered when deciding the treatment option in emergency surgery for severe pancreatic fistulas.

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Title: External Tube Pancreatostomy Reduces the Risk of Mortality Associated with Completion Pancreatectomy for Symptomatic Fistulas Complicating Pancreaticoduodenectomy
Authors: Dario Ribero
Marco Amisano
Giuseppe Zimmitti
Francesco Giraldi
Alessandro Ferrero
Lorenzo Capussotti
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 2/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-2100-6

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External Tube Pancreatostomy Reduces the Risk of Mortality Associated with Completion Pancreatectomy for Symptomatic Fistulas Complicating Pancreaticoduodenectomy

Abstract

Objective

Background data

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Background data

Methods

Results

Conclusions

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