[Prevention of pancreatic fistula after cephalic duodenopancreatectomy].

A pancreatic fistula occurs in about 10% of cases after Whipple's procedure. This complication is associated with a mortality rate ranging from 7% to 30%. The main predisposing factor of pancreatic fistula is a soft pancreatic parenchyma. Several procedures have been proposed to decrease the rate of this complication. Occlusion of the residual stump is infrequently used and does not clearly reduce the rate of this complication. Pancreaticojejunostomy is the technique most frequently used. No alternative technique is clearly superior to pancreaticojejunostomy. Pancreaticogastrostomy and pancreaticojejunostomy have equivalent early results. Superiority of transient intubation of the Wirsung duct and mucosa-to-mucosa anastomosis is not demonstrated. Among the 7 controlled randomized studies which tested somatostatin or its analogs, many have methodological insufficiencies which prevent definite conclusions. Meanwhile, most studies suggest that these drugs decrease the rate of pancreatic fistula after pancreaticoduodenectomy. Further evaluation in high-risk patients (soft pancreatic parenchyma) is advisable.