ORIGINAL ARTICLE
Postoperative Pancreatic Fistula in Distal Pancreatectomy Experience From 1 Institution Hangyan Wang, MD, Dianrong Xiu, MD, Bin Jiang, MD, Chaolai Ma, MD, and Chunhui Yuan, MD, PhD
Objective: Postoperative pancreatic fistula (POPF) and readmission remain the significant sources of morbidity after distal pancreatectomy (DP). We describe a technique of drainage and postoperation management to prevent severe POPF and readmission. Methods: A retrospective analysis of 57 patients who underwent DP from January 2009 to November 2011 was conducted. The drain was placed just abutting the pancreatic stump by suturing the tissue near the stump. Each patient was discharged carrying an intraabdominal drain, and a strict follow-up was made in the outpatient clinic. Postoperative pancreatic fistula was defined using the international study group classification for pancreatic fistula definition. Results: Thirty-two patients accepted laparoscopic DP (LDP), and 25 patients accepted open DP (ODP). There was no significant difference in the rate of POPF between the 2 groups (12/32 vs 11/25, P = 0.786). All the POPF cases were grades A and B, but no case was grade C. No case needed a specific intervention. There was no reoperation, readmission, intraabdominal abscess, or surgical site infection. Conclusions: We conclude that our technique of drainage and postoperation management is associated with a low incidence of severe POPF and readmission. Continued investigation of this technique is warranted. Key Words: distal pancreatectomy, postoperative pancreatic fistula, drainage (Pancreas 2014;43: 588Y591)
P
ostoperative pancreatic fistula (POPF) is a common cause of morbidity in distal pancreatectomy (DP). Although many modifications have been reported, POPF still cannot be totally avoided. Unfortunately, most POPF cases have clinical symptoms and need specific intervention.1 How to prevent POPF is still a great challenge for pancreatic surgeons, especially in laparoscopic DP (LDP). Laparoscopy has been the revolutionary change in general surgery, which has been widely used in colorectal surgery, splenectomy, gastrectomy, hepatectomy, common bile duct exploration, and especially cholecystectomy as criterion standard. However, because of the deep site of pancreas and the complexity of anatomy, laparoscopic pancreatic surgery is considered to be a great challenge. The benefits of laparoscopic pancreatic surgery have been proved, such as decreased blood loss and decreased length of stay. Whether in open or laparoscopic pancreatic surgery, postoperative morbidity remains a daunting reality, especially in POPF and readmission. However, a wide variation in the definition of
From the Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China. Received for publication March 24, 2013; accepted December 19, 2013. Reprints: Dianrong Xiu, MD, Department of General Surgery, Peking University Third Hospital, 49 N Garden Rd., Haidian District, Beijing 10019, People’s Republic of China (e
Postoperative Pancreatic Fistula in Distal Pancreatectomy Experience From 1 Institution Hangyan Wang, MD, Dianrong Xiu, MD, Bin Jiang, MD, Chaolai Ma, MD, and Chunhui Yuan, MD, PhD
Objective: Postoperative pancreatic fistula (POPF) and readmission remain the significant sources of morbidity after distal pancreatectomy (DP). We describe a technique of drainage and postoperation management to prevent severe POPF and readmission. Methods: A retrospective analysis of 57 patients who underwent DP from January 2009 to November 2011 was conducted. The drain was placed just abutting the pancreatic stump by suturing the tissue near the stump. Each patient was discharged carrying an intraabdominal drain, and a strict follow-up was made in the outpatient clinic. Postoperative pancreatic fistula was defined using the international study group classification for pancreatic fistula definition. Results: Thirty-two patients accepted laparoscopic DP (LDP), and 25 patients accepted open DP (ODP). There was no significant difference in the rate of POPF between the 2 groups (12/32 vs 11/25, P = 0.786). All the POPF cases were grades A and B, but no case was grade C. No case needed a specific intervention. There was no reoperation, readmission, intraabdominal abscess, or surgical site infection. Conclusions: We conclude that our technique of drainage and postoperation management is associated with a low incidence of severe POPF and readmission. Continued investigation of this technique is warranted. Key Words: distal pancreatectomy, postoperative pancreatic fistula, drainage (Pancreas 2014;43: 588Y591)
P
ostoperative pancreatic fistula (POPF) is a common cause of morbidity in distal pancreatectomy (DP). Although many modifications have been reported, POPF still cannot be totally avoided. Unfortunately, most POPF cases have clinical symptoms and need specific intervention.1 How to prevent POPF is still a great challenge for pancreatic surgeons, especially in laparoscopic DP (LDP). Laparoscopy has been the revolutionary change in general surgery, which has been widely used in colorectal surgery, splenectomy, gastrectomy, hepatectomy, common bile duct exploration, and especially cholecystectomy as criterion standard. However, because of the deep site of pancreas and the complexity of anatomy, laparoscopic pancreatic surgery is considered to be a great challenge. The benefits of laparoscopic pancreatic surgery have been proved, such as decreased blood loss and decreased length of stay. Whether in open or laparoscopic pancreatic surgery, postoperative morbidity remains a daunting reality, especially in POPF and readmission. However, a wide variation in the definition of
From the Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China. Received for publication March 24, 2013; accepted December 19, 2013. Reprints: Dianrong Xiu, MD, Department of General Surgery, Peking University Third Hospital, 49 N Garden Rd., Haidian District, Beijing 10019, People’s Republic of China (e
