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Arab Journal of Gastroenterology : the... Mar 2012Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the...
Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage.
Topics: Cholangiopancreatography, Magnetic Resonance; Humans; Male; Middle Aged; Pancreatic Fistula; Pancreatitis, Alcoholic; Pleural Diseases
PubMed: 22560825
DOI: 10.1016/j.ajg.2012.03.002 -
Pancreatology : Official Journal of the... Apr 2022Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated...
BACKGROUND
Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population.
METHODS
All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014-2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios.
RESULTS
1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6-26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multivariable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180-0.834, p = 0.015). In-hospital mortality rates were not affected.
CONCLUSION
Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings.
Topics: Humans; Octreotide; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Risk Factors; Somatostatin
PubMed: 35304104
DOI: 10.1016/j.pan.2022.03.006 -
The American Surgeon Aug 2009Pancreatic fistula have been a source of significant morbidity and mortality after left-sided pancreatectomy. The majority of fistulas are classified as Grade A and...
Pancreatic fistula have been a source of significant morbidity and mortality after left-sided pancreatectomy. The majority of fistulas are classified as Grade A and resolve quickly with no intervention. Grade C pancreatic fistulas, which require percutaneous or operative drainage, are less common and may be associated with morbidity and mortality. We used postoperative endoscopic pancreatic stent placement as an adjunctive strategy in the management of refractory Grade C pancreatic fistulas. Patients undergoing endoscopic pancreatic stent placement for persistent, refractory peripancreatic fluid collections/pancreatic fistula after left-sided pancreatectomy were identified. Eight patients underwent endoscopic pancreatic stent placement for refractory Grade C pancreatic fistulas. Six patients had percutaneous catheter placement; two patients had transgastric drainage. Endoscopic retrograde cholangiopancreatography (ERCP) showed extravasation of contrast from the distal end of the pancreatic duct in seven patients. Pancreatic stents were placed in all patients at a median time of 48 days postoperation and left for a median of 47 days. Before stent removal, ERCP demonstrated pancreatic fistula closure. Median time to complete resolution of the fistula was 41 days after stent placement. Endoscopic pancreatic stents were associated with resolution of Grade C fistulas. After distal pancreatectomy, pancreatic stent placement should be considered in the postoperative period for refractory pancreatic fistulas.
Topics: Adult; Aged; Catheterization; Cohort Studies; Endoscopy; Female; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Ducts; Pancreatic Fistula; Radiography; Retrospective Studies; Stents; Treatment Outcome
PubMed: 19725286
DOI: No ID Found -
PloS One 2017To validate preoperative dynamic CT and fecal elastase-1 level in predicting the development of pancreatic fistulae after pancreatoduodenectomy.
OBJECTIVE
To validate preoperative dynamic CT and fecal elastase-1 level in predicting the development of pancreatic fistulae after pancreatoduodenectomy.
MATERIALS AND METHODS
For 146 consecutive patients, CT attenuation values of the nontumorous pancreatic parenchyma were retrospectively measured on precontrast, arterial and equilibrium phase images for calculation of enhancement ratios. CT enhancement ratios and preoperative fecal elastase-1 levels were correlated with the development of pancreatic fistulae using independent t-test, logistic regression models, ROC analysis, Youden method and tree analysis.
RESULTS
The mean value of enhancement ratio on equilibrium phase was significantly higher (p = 0.001) in the patients without pancreatic fistula (n = 107; 2.26±3.63) than in the patients with pancreatic fistula (n = 39; 1.04±0.51); in the logistic regression analyses, it was significant predictor for the development of pancreatic fistulae (odds ratio = 0.243, p = 0.002). The mean preoperative fecal elastase-1 levels were higher (odds ratio = 1.003, p = 0.034) in the pancreatic fistula patients than other patients, but there were no significant differences in the areas under the curve between the prediction values of CT enhancement ratios and fecal elastase-1 combined and those of CT enhancement ratios alone (P = 0.897, p = 0.917) on ROC curve analysis. Tree analysis revealed that the CT enhancement ratio was more powerful predictor of pancreatic fistula than fecal elastase-1 levels.
CONCLUSION
The preoperative CT enhancement ratio of pancreas acquired at equilibrium phase regardless of combination with fecal elastase-1 levels might be a useful predictor of the risk of developing a pancreatic fistula following pancreatoduodenectomy.
Topics: Female; Humans; Logistic Models; Male; Middle Aged; Pancreas; Pancreatic Ducts; Pancreatic Elastase; Pancreatic Fistula; Pancreaticoduodenectomy; Preoperative Period; ROC Curve; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 28493949
DOI: 10.1371/journal.pone.0177052 -
Digestive Surgery 2004Pancreatic fistula (PF) is still regarded as a serious complication both in terms of frequency and sequelae. The incidence varies greatly in different reports because of... (Comparative Study)
Comparative Study
BACKGROUND
Pancreatic fistula (PF) is still regarded as a serious complication both in terms of frequency and sequelae. The incidence varies greatly in different reports because of the different definitions used. The aim of this study was to compare several definitions of PF encountered in the current literature and to demonstrate that the PF rate in the same group of patients treated in a high volume center is dependent upon the definition applied.
METHODS
A Medline search of the last 10 years was performed as regards the definition of PF. A score was assigned to the reproducible definitions based upon two basic parameters: daily output (cm3) and duration of the fistula represented by the number of days between the postoperative day of onset and the duration of the complication. Four definitions were formulated and were then applied to a group of 242 patients that underwent pancreatic head or intermediate resections with pancreatico-jejunal anastomosis in our Pancreatic Unit between November 1996 and December 2000. Statistical analysis was carried out using the Yates correct chi2 test with statistical significance set at p < 0.05.
RESULTS
Among 26 different definitions identified, 14 were found suitable for the applied score. We formulated four final definitions summarizing the current concepts of PF. The incidence of PF ranged between 9.9 and 28.5% according to the different definitions applied with highly statistical differences between them.
CONCLUSIONS
The PF rate after pancreatic resections is strictly dependent upon the definition used. An overall general agreement for an internationally accepted definition is urgently needed to correctly compare different experiences.
Topics: Anastomosis, Surgical; Humans; Pancreas; Pancreatic Fistula; Pancreatic Function Tests; Pancreaticoduodenectomy; Terminology as Topic
PubMed: 14707394
DOI: 10.1159/000075943 -
Journal of the College of Physicians... Oct 2021To analyse clinicopathological variables to determine risk factors of postoperative pancreatic fistula in patients having distal pancreatectomy with stapler closure. (Observational Study)
Observational Study
OBJECTIVE
To analyse clinicopathological variables to determine risk factors of postoperative pancreatic fistula in patients having distal pancreatectomy with stapler closure.
STUDY DESIGN
Observational study.
PLACE AND DURATION OF STUDY
Adana City Training and Research Hospital, Adana, Turkey, from January 2015 to May 2020.
METHODOLOGY
Medical files of 38 cases having distal pancreatectomy with stapler closure of the pancreatic remnant for conditions emerging from the pancreas or other organs were analysed. Data about demographics, perioperative and pathological findings, postoperative outcomes were gathered. Univariate analysis was utilised for comparisons of categorical data. The possible risk factors found to be significant in the univariate analysis were included into the logistic regression analysis.
RESULTS
Based on the description reported by the International Study Group of Pancreatic Surgery, 23.7% and 31.6% of the patients had biochemical leakage and clinically relevant postoperative pancreatic fistula (POPF) respectively. Univariate and multivariate analyses made to determine risk factors of POPF showed a relation between stapler closure alone (p = 0.018) and soft parenchymal texture (p = 0.002) and clinically relevant POPF. Multivariate analyses revealed that parenchymal texture was the sole independent predictor of clinically relevant POPF (OR, 0.016, p = 0.039).
CONCLUSION
Soft pancreatic texture is independently predictive of clinically relevant POPF following distal pancreatectomy with stapler closure. However, reinforcement of the stapler line with extra sutures decreases the risk of clinically relevant POPF. Key Words: Distal pancreatectomy, Pancreatic fistula, Stapler closure, Suture reinforcement.
Topics: Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Postoperative Period; Risk Factors
PubMed: 34601844
DOI: 10.29271/jcpsp.2021.10.1214 -
Journal of Gastrointestinal Surgery :... Mar 2007Clinically relevant fistula after distal pancreatic resection occurs in 5-30% of patients, prolonging recovery and considerably increasing in-hospital stay and costs. We...
Clinically relevant fistula after distal pancreatic resection occurs in 5-30% of patients, prolonging recovery and considerably increasing in-hospital stay and costs. We tested whether routine drainage of the pancreatic stump into a Roux-en-Y limb after distal pancreatic resection decreased the incidence of fistula. From October 2001, data of all patients undergoing pancreatic distal resection were entered in a prospective database. From June 2003 after resection, the main pancreatic duct and the pancreatic stump were oversewn, and in addition, anastomosed into a jejunal Roux-en-Y limb by a single-layer suture (n = 23). A drain was placed near the anastomosis, and all patients received octreotide for 5-7 days postoperatively. The volume of the drained fluid was registered daily, and concentration of amylase was measured and recorded every other day. Patient demographics, hospital stay, pancreatic fistula incidence (> or =30 ml amylase-rich fluid/day on/after postoperative day 10), perioperative morbidity, and follow-up after discharge were compared with our initial series of patients (treated October 2001-May 2003) who underwent oversewing only (n = 20). Indications, patient demographics, blood loss, and tolerance of an oral diet were similar. There were four (20%) pancreatic fistulas in the "oversewn" group and none in the anastomosis group (p < 0.05). Nonsurgical morbidity, in-hospital stay, and follow-up were comparable in both groups.
Topics: Adult; Aged; Anastomosis, Roux-en-Y; Drainage; Female; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Fistula; Pancreaticojejunostomy; Suture Techniques
PubMed: 17458602
DOI: 10.1007/s11605-007-0094-2 -
Endoscopy May 2020
Topics: Drainage; Endosonography; Humans; Pancreas; Pancreatic Fistula; Ultrasonography, Interventional
PubMed: 31791107
DOI: 10.1055/a-1045-4324 -
American Journal of Surgery Jul 2022Fistula Risk Score (FRS) models often lack adequate discrimination for clinically relevant postoperative pancreatic fistula (CR-POPF) on external validation. We tested...
BACKGROUND
Fistula Risk Score (FRS) models often lack adequate discrimination for clinically relevant postoperative pancreatic fistula (CR-POPF) on external validation. We tested four FRS models in the Deep South United States and sought to determine if CR-POPF discrimination was affected by racial disparities.
METHODS
A single-institution retrospective cohort study of patients who underwent pancreatoduodenectomies between 2013 and 2019 was performed. FRS discrimination for CR-POPF was assessed using ROC curves for both the entire patient population, and for Black vs White patients.
RESULTS
The Alternative FRS maintains adequate CR-POPF discrimination when considering the patient population as a whole, but inadequately predicts CR-POPF when applied to the Black patient population. The Sun-FRS provides adequate CR-POPF discrimination for Black patients when considering risk grade. Only soft pancreatic gland texture and small duct size were significantly associated with CR-POPF in this patient population.
DISCUSSION
Institutions should assess their preferred FRS model to determine if it provides adequate CR-POPF discrimination among a racially diverse patient population. Further studies are needed to determine how racial disparities influence CR-POPF prediction to better guide postoperative management.
Topics: Humans; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Risk Assessment; Risk Factors
PubMed: 35219491
DOI: 10.1016/j.amjsurg.2022.02.042 -
World Journal of Gastroenterology Dec 2014To explore the morbidity and risk factors of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy.
AIM
To explore the morbidity and risk factors of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy.
METHODS
The data from 196 consecutive patients who underwent pancreaticoduodenectomy, performed by different surgeons, in the General Hospital of the People's Liberation Army between January 1(st), 2013 and December 31(st), 2013 were retrospectively collected for analysis. The diagnoses of POPF and clinically relevant (CR)-POPF following pancreaticoduodenectomy were judged strictly by the International Study Group on Pancreatic Fistula Definition. Univariate analysis was performed to analyze the following factors: patient age, sex, body mass index (BMI), hypertension, diabetes mellitus, serum CA19-9 level, history of jaundice, serum albumin level, blood loss volume, pancreatic duct diameter, pylorus preserving pancreaticoduodenectomy, pancreatic drainage and pancreaticojejunostomy. Multivariate logistic regression analysis was used to determine the main independent risk factors for POPF.
RESULTS
POPF occurred in 126 (64.3%) of the patients, and the incidence of CR-POPF was 32.7% (64/196). Patient characteristics of age, sex, BMI, hypertension, diabetes mellitus, serum CA19-9 level, history of jaundice, serum albumin level, blood loss volume, pylorus preserving pancreaticoduodenectomy and pancreaticojejunostomy showed no statistical difference related to the morbidity of POPF or CR-POPF. Pancreatic duct diameter was found to be significantly correlated with POPF rates by univariate analysis and multivariate regression analysis, with a pancreatic duct diameter ≤ 3 mm being an independent risk factor for POPF (OR = 0.291; P = 0.000) and CR-POPF (OR = 0.399; P = 0.004). The CR-POPF rate was higher in patients without external pancreatic stenting, which was found to be an independent risk factor for CR-POPF (OR = 0.394; P = 0.012). Among the entire patient series, there were three postoperative deaths, giving a total mortality rate of 1.5% (3/196), and the mortality associated with pancreatic fistula was 2.4% (3/126).
CONCLUSION
A pancreatic duct diameter ≤ 3 mm is an independent risk factor for POPF. External stent drainage of pancreatic secretion may reduce CR-POPF mortality and POPF severity.
Topics: Aged; Chi-Square Distribution; China; Drainage; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pancreatic Ducts; Pancreatic Fistula; Pancreaticoduodenectomy; Retrospective Studies; Risk Factors; Severity of Illness Index; Stents; Treatment Outcome
PubMed: 25516663
DOI: 10.3748/wjg.v20.i46.17491