Gripon S, Bouillot J L, Rolland E, Alexandre J H
Clinique Chirurgicale, Hôpital Broussais, Paris.
J Chir (Paris). 1988 Mar;125(3):161-5.
A frequent complication (8.5 to 52.8%) of pancreatoduodenectomy (PD) for cancer, pancreatic fistula (PF) is difficult to treat, and an analysis of 30 cases of PD (27 for cancer, 3 for chronic pancreatitis) is used to determine risk factors and most effective therapy. Fistula developed in 6 cases (20%) and three risk factors were determined: preoperative renal impairment and hypoalbuminemia and ligature of pancreatic stump. Although not statistically significant, other factors--cancer, emergency surgery, fragile pancreatic tissue, thin Wirsung, pancreatojejunal anastomosis, absence of decompression of the raised jejunal loop--in this small series nevertheless provoked a marked increase in PF. One patient recovered after medical treatment, all five patients operated upon by whatever technique failing to survive. This agrees with literature data indicating heavy mortality (44.4 to 100%) after surgery. This should therefore be reserved for cases of PF failing to respond to adequate medical treatment, or with hemorrhage or intra-abdominal sepsis not controlled medically. The most effective therapy for PF is prophylactic, combining selection of patients as a function of risk factors, and treatment of pancreatic stump adapted to caliber of Wirsung and quality of remaining pancreatic tissue.
