[Leakage after biliary and pancreatic surgery].

The frequency of anastomotic leaks after pancreatic resection is still significant. The majority of such leaks will heal without major clinical symptoms. In one fifth of patients, however, the sequelae of pancreatic leakage are serious and sometimes life-threatening. Management of such leaks ranges from local drainage to operative revision and completion pancreatectomy. The frequency of anastomotic leakage depends on a series of patient- and organ-specific risk factors. Surgical experience also plays a major role. Whether the prophylactic application of octreotide is able to reduce the frequency of pancreatic leaks is still a matter of debate. Leaks from direct bile duct sutures or biliodigestive anastomoses are rather seldom. Their clinical importance is limited. In case of a leak after direct bile duct anastomosis, endoscopic insertion of a stent seems to be the therapy of choice. Leaks from biliodigestive anastomoses which are diagnosed during the first 3 postoperative days should be treated by immediate operative revision. Late biliary leaks can be treated by local drainage. The results of bile duct surgery, too, are clearly dependent on the experience of the operating surgeon.