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Pancreatic Fistula and Delayed Gastric Emptying After Pancreatectomy: Where do We Stand?

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Abstract

Pancreatic resection has become a feasible treatment of pancreatic neoplasms, and with improvements in surgical techniques and perioperative management, mortality associated with pancreatic surgery has decreased considerably. Despite this improvement, a high rate of complications is still associated with these procedures. Among these complications, delayed gastric emptying (DGE) and postoperative pancreatic fistula (POPF) have a substantial impact on patient outcomes and burden our healthcare system. Technical modifications and postoperative approaches have been proposed to reduce rates of both POPF and DGE in patients undergoing pancreatectomy; however, to date, their rates have remained unchanged. In the present study, we summarize the findings of the most significant studies that have investigated these complications. In particular, several studies focused on technical modifications including extent of dissection, stent placement, nature of anastomosis, type of reconstruction, and application of biological or non-biological agents to site of anastomosis. Moreover, postoperatively, drain placement, duration of drain usage, postoperative feeding, and use of pharmacological agents were studied to reduce rates of POPF and DGE. In this review, we summarize the most relevant literature on this fundamental aspect of pancreatic surgery. Despite studies identifying the potential benefit of technical modifications and postoperative approaches, these findings remain controversial and suggest need for further extensive investigation. Most importantly, we recommend that all surgeons performing these procedures base their practice on the most updated and highest available level of evidence.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, 685 Blalock, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Ammar A. Javed, Kanza Aziz, Fabio Bagante & Christopher L. Wolfgang

  2. Center of Research Excellence and Surgical Trials, Johns Hopkins Hospital, 611 Blalock, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Ammar A. Javed

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Javed, A.A., Aziz, K., Bagante, F. et al. Pancreatic Fistula and Delayed Gastric Emptying After Pancreatectomy: Where do We Stand?. Indian J Surg 77, 409–425 (2015). https://doi.org/10.1007/s12262-015-1366-9

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