Skip to main content
SpringerLink
Log in

Management der postoperativen Pankreasfistel

Management of postoperative pancreatic fistula

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Das Auftreten einer postoperativen Pankreasfistel ist eine der wichtigsten Komplikationen nach Pankreasresektionen. Die Häufigkeit dieser Komplikation variiert zwischen 3 % nach Pankreaskopfresektionen und bis zu 35 % nach distaler Pankreatektomie. Im Jahr 2005 wurde die internationale Definition der postoperativen Pankreasfistel durch die International Study Group of Pancreatic Surgery (ISGPS) standardisiert und eine Abstufung des Schweregrades von A bis C eingeführt. Dadurch wurden die Ergebnisse unterschiedlicher Studien vergleichbar und die davor publizierten historischen Fistelraten konnten differenziert beurteilt werden. Die vorliegende Übersichtsarbeit fasst die aktuelle Literatur zu Inzidenz, Risikofaktoren, fistelassoziierten Komplikationen und Management der postoperativen Pankreasfistel zusammen.

Abstract

The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication varies between 3 % after pancreatic head resection and up to 35 % following distal pancreatectomy. In 2005, the international definition of postoperative pancreatic fistula was standardized according to the approach of the International Study Group of Pancreatic Surgery (ISGPS) including an A–C grading system of the severity. Consequently, results from different studies have become comparable and the historically reported fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, fistula-associated complications and management of postoperative pancreatic fistula.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Balzano G, Pecorelli N, Piemonti L, Ariotti R, Carvello M, Nano R, Braga M, Staudacher C (2014) Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy: a comparison of different surgical strategies. HPB (Oxford) 16:40–45

    Article  Google Scholar 

  2. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  3. Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214

    Article  PubMed  Google Scholar 

  4. Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP (2009) Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 13:1129–1137

    Article  PubMed  Google Scholar 

  5. Daskalaki D, Butturini G, Molinari E, Crippa S, Pederzoli P, Bassi C (2011) A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients. Langenbecks Arch Surg 396:91–98

    Article  PubMed  Google Scholar 

  6. Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522

    Article  PubMed  Google Scholar 

  7. Dong Z, Xu J, Wang Z, Petrov MS (2013) Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy. Cochrane Database Syst Rev 6:CD008914

    PubMed  Google Scholar 

  8. Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, Rodriguez R, Thayer SP, Fernandez-del Castillo C (2008) Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 12:1691–1697

    Article  PubMed Central  PubMed  Google Scholar 

  9. Gans SL, van Westreenen HL, Kiewiet JJ, Rauws EA, Gouma DJ, Boermeester MA (2012) Systematic review and meta-analysis of somatostatin analogues for the treatment of pancreatic fistula. Br J Surg 99:754–760

    Article  CAS  PubMed  Google Scholar 

  10. Gurusamy KS, Koti R, Fusai G, Davidson BR (2013) Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev 4:CD008370

    PubMed  Google Scholar 

  11. Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, Büchler MW, Werner (2011) Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbecks Arch Surg 396:1197–1203

  12. Hackert T, Schneider L, Büchler MW (2013) Surgical approach to chronic pancreatitis: draining and resection procedures. Chirurg 84:112–116

    Article  CAS  PubMed  Google Scholar 

  13. Hackert T, Werner J, Büchler MW (2011) Postoperative pancreatic fistula. Surgeon 9:211–217

    Article  PubMed  Google Scholar 

  14. Imaizumi T, Hatori T, Tobita K, Fukuda A, Takasaki K, Makuuchi H (2006) Pancreaticojejunostomy using duct-to-mucosa anastomosis without a stenting tube. J Hepatobiliary Pancreat Surg 13:194–201

    Article  PubMed  Google Scholar 

  15. Kleeff J, Diener MK, Z’graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Müller MW, Friess H, Büchler MW (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kleespies A, Albertsmeier M, Obeidat F, Seeliger H, Jauch KW, Bruns CJ (2008) The challenge of pancreatic anastomosis. Langenbecks Arch Surg 393:459–471

    Article  PubMed  Google Scholar 

  17. Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 157:45–55

    Article  PubMed  Google Scholar 

  18. Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J (2007) External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg 246:425–433

    Article  PubMed Central  PubMed  Google Scholar 

  19. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, Traverso LW, Pancreatic Anastomotic Leak Study Group (2007) Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg. 11:1451–1458.

    Article  PubMed  Google Scholar 

  20. Roder JD, Stein HJ, Böttcher KA, Busch R, Heidecke CD, Siewert JR. (1999) Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann Surg 229:41–48

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Sauvanet A, Gaujoux S, Blanc B, Couvelard A, Dokmak S, Vullierme MP, Ruszniewski P, Belghiti J, Lévy P (2014) Parenchyma-sparing pancreatectomy for presumed noninvasive intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 260:364–371

    Article  PubMed  Google Scholar 

  22. Seeliger H, Christians S, Angele MK, Kleespies A, Eichhorn ME, Ischenko I, Boeck S, Heinemann V, Jauch KW, Bruns CJ (2010) Risk factors for surgical complications in distal pancreatectomy. Am J Surg 200:311–317

    Article  PubMed  Google Scholar 

  23. Stampfl U, Hackert T, Sommer CM, Klauss M, Bellemann N, Siebert S, Werner J, Richter GM, Kauczor HU, Radeleff B (2012) Superselective embolization for the management of postpancreatectomy hemorrhage: a single-center experience in 25 patients. J Vasc Interv Radiol 23:504–510

    Article  PubMed  Google Scholar 

  24. Tol JA, Busch OR, van Delden OM, van Lienden KP, van Gulik TM, Gouma DJ (2014) Shifting role of operative and nonoperative interventions in managing complications after pancreatoduodenectomy: what is the preferred intervention? Surgery 156:622–631

    Article  PubMed  Google Scholar 

  25. Wellner U, Keck T (2015) Pankreatogastrostomie versus Pankreatojejuno-stomie (RECOPANC) – perioperative und Langzeitergebnisse einer multizentrischen randomisierten Studie. 35. Deutscher Pankreasclub, 22.-24.01.2015, Rostock

  26. Wente MN, Shrikhande SV, Müller MW, Diener MK, Seiler CM, Friess H, Büchler MW (2007) Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 193:171–183

    Article  PubMed  Google Scholar 

  27. Winter JM, Cameron JL, Campbell KA, Chang DC, Riall TS, Schulick RD, Choti MA, Coleman J, Hodgin MB, Sauter PK, Sonnenday CJ, Wolfgang CL, Marohn MR, Yeo CJ (2006) Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg 10:1280–1290

    Article  PubMed  Google Scholar 

  28. Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, Jiang JX, Hu J, Wang M, Qin RY (2015) Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg 102:4–15

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    T. Hackert & M. W. Büchler

Authors
  1. T. Hackert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Hackert.

Ethics declarations

Interessenkonflikt

T. Hackert und M.W. Büchler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hackert, T., Büchler, M. Management der postoperativen Pankreasfistel. Chirurg 86, 519–524 (2015). https://doi.org/10.1007/s00104-015-0003-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-015-0003-2

Schlüsselwörter

Keywords

Search

Navigation