Pancreatic fistula formation after pancreaticooduodenectomy; for prevention of this deep surgical site infection after pancreatic surgery.

BACKGROUND/AIMS: The operative mortality and morbidity associated with pancreatoduodenectomy (PD) has been decreasing, however, pancreatic fistula remains a major cause of a potentially fatal complication. The aim of this study was to identify risk factors, predictors and prevention for pancreatic fistula formation in a consecutive series of PD cases in a single institution.

METHODOLOGY

The association between pancreatic fistula formation and various clinical parameters was investigated in 100 patients who underwent PD at Kochi Medical School from April 1999 through December 2007.

RESULTS

The incidence of pancreatic fistula in these patients was 18%. Multivariate analysis identified 4 independent parameters correlating with occurrence of pancreatic fistula: (1) no use with ultrasonically activated scalpel on the pancreatic transaction (odds ratio, 2.1; 95% confidence interval, 1.2-3.8; p = 0.001); (2) no performance with duct-to-mucosa anastomosis for pancreatico-enteric reconstruction (4.3; 1.1-16.1; p = 0.006); (3) not having early postoperative enteral nutrition through the jejunostomy catheter (2.3; 1.1-5.0; p = 0.007); and (4) serum amylase concentration greater than 194 U/L (1.7 times the normal upper limit) on the first postoperative day (2.0; 1.1-3.9; p = 0.019).

CONCLUSION

The current study suggested that the reconstruction of duct-to-mucosa anastomosis for pancreatico-jejunostomy by using the ultrasonically activated scalpel and the use of early postoperative enteral nutrition should be attempted as a means to reduce the incidence of pancreatic fistula after PD.