BACKGROUND: Postoperative pancreatic fistula (POPF) is responsible for severe complications and death in patients who underwent pancreatic surgery. The reported success rate of conservative treatment is around 80%. Therefore up to 20% of patients usually need surgical treatment that can be repeated in some. Uncontrolled sepsis and massive hemorrhage are the main causes for mortality in this setting. METHOD: Four hundred forty-five patients underwent surgery for pancreatic diseases (January 1993-August 2007); 70 of them developed a POPF. An early aggressive treatment based on interventional radiology was applied to all patients. The drain's track and/or percutaneous approach was used to insert catheters into the peripancreatic fluid collection/s or abscess/es. The position of catheters was verified at least once a week. Surgery was performed in case of failure of conservative approach. RESULTS: Conservative treatment (approach by drain's track in 49, percutaneous in 16, mixed in 2) was successful in 67 patients. A patient under dialysis had the drains inserted during an emergency surgery for peritonitis 6 days after surgery; a second patient underwent repeated surgical debridement, and a third patient underwent a procedure on the abdominal wall to separate a POPF from a colonic fistula. No patient with diagnosed POPF died. CONCLUSIONS: Early aggressive interventional radiology allowed managing conservatively 95.7% of POPF preventing severe complications and avoiding death.
BACKGROUND:Postoperative pancreatic fistula (POPF) is responsible for severe complications and death in patients who underwent pancreatic surgery. The reported success rate of conservative treatment is around 80%. Therefore up to 20% of patients usually need surgical treatment that can be repeated in some. Uncontrolled sepsis and massive hemorrhage are the main causes for mortality in this setting. METHOD: Four hundred forty-five patients underwent surgery for pancreatic diseases (January 1993-August 2007); 70 of them developed a POPF. An early aggressive treatment based on interventional radiology was applied to all patients. The drain's track and/or percutaneous approach was used to insert catheters into the peripancreatic fluid collection/s or abscess/es. The position of catheters was verified at least once a week. Surgery was performed in case of failure of conservative approach. RESULTS: Conservative treatment (approach by drain's track in 49, percutaneous in 16, mixed in 2) was successful in 67 patients. A patient under dialysis had the drains inserted during an emergency surgery for peritonitis 6 days after surgery; a second patient underwent repeated surgical debridement, and a third patient underwent a procedure on the abdominal wall to separate a POPF from a colonic fistula. No patient with diagnosed POPF died. CONCLUSIONS: Early aggressive interventional radiology allowed managing conservatively 95.7% of POPF preventing severe complications and avoiding death.
Authors: Ye Rim Chang; Jae Seung Kang; Jin-Young Jang; Woo Hyun Jung; Mee Joo Kang; Kyung Bun Lee; Sun-Whe Kim Journal: World J Surg Date: 2017-06 Impact factor: 3.352
Authors: Max Almond; Keith J Roberts; James Hodson; Robert Sutcliffe; Ravi Marudanayagam; John Isaac; Paolo Muiesan; Darius Mirza Journal: HPB (Oxford) Date: 2014-11-19 Impact factor: 3.647
Authors: Sebastian Hempel; Steffen Wolk; Christoph Kahlert; Stephan Kersting; Jürgen Weitz; Thilo Welsch; Marius Distler Journal: Langenbecks Arch Surg Date: 2017-06-08 Impact factor: 3.445