Skip to main content

Advertisement

SpringerLink
Log in

Distal Pancreatectomy for Chronic Pancreatitis: Risk Factors for Postoperative Pancreatic Fistula

  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

One of the most common complications after distal pancreatectomy is a fistula from the pancreatic remnant. Factors influencing the development of a pancreatic fistula after distal pancreatectomy have not been clearly elucidated. The records of 91 patients who underwent distal pancreatectomy for chronic pancreatitis between 1995 and 2003 were retrospectively reviewed and analyzed. Average daily volume and amylase concentration between postoperative days 2 and 20 from drains located at the pancreatic resection site were compared to clinical variables. Out of 137 pre- and intraoperative clinical variables, multivariate analysis showed serum creatinine (t = 3.05, p = 0.004), history of intraabdominal operation (t = −2.68, p = 0.01), right-sided pancreatic duct dilation (t = 2.65, p = 0.01), synchronous cholecystectomy (t = 2.53, p = 0.02), and serum albumin (t = −2.19, p = 0.04) to be independently associated with drain volume. Drain amylase concentration was linked to serum creatinine (t = 8.55, p < 0.001), blood urea nitrogen (t = −3.43, p = .001), preoperative parenteral nutrition (t = 2.56, p = .01), and serum alkaline phosphatase (t = 2.51, p = 0.01). There was no correlation between the degree of fibrosis and drain output. Technique of pancreatic transection and presence of suture closure of the pancreatic duct did not affect drain output. In conclusion, the amount and amylase concentration of postsurgical drainage after distal pancreatectomy for chronic pancreatitis is dependent on markers of renal dysfunction, malnutrition, biliary disease, and possibly inflammation. These factors, if medically reversible, should be addressed in patients who are candidates for distal pancreatectomy for chronic pancreatitis.

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

Figure 1

Similar content being viewed by others

References

  1. Rattner DW, Fernandez-del Castillo C, Warshaw AL. Pitfalls of distal pancreatectomy for relief of pain in chronic pancreatitis. Am J Surg 1996;171:142–146.

    Article  PubMed  CAS  Google Scholar 

  2. Sakorafas GH, Sarr MG, Rowland CM, Farnell MB. Postobstructive chronic pancreatitis: results with distal resection. Arch Surg 2001;136:643–648.

    Article  PubMed  CAS  Google Scholar 

  3. Schoenberg MH, Schlosser W, Ruck W, Beger HG. Distal pancreatectomy in chronic pancreatitis. Dig Surg 1999;16:130–136.

    Article  PubMed  CAS  Google Scholar 

  4. Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RCN. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg 2002;236:612–618.

    Article  PubMed  Google Scholar 

  5. 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. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.

    Article  PubMed  Google Scholar 

  6. Rodriguez JR, Germes SS, Pandharipande PV, Gazelle GS, Thayer SP, Warshaw AL, Fernandez-del Castillo C. Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg 2006;141:361–366.

    Article  PubMed  Google Scholar 

  7. Ammann RW, Heitz PU, Kloppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphologic long-term study. Gastroenterology 1996;111:224–231.

    Article  PubMed  CAS  Google Scholar 

  8. Adam U, Makowiec F, Riediger H, Benz S, Liebe S, Hopt UT. Pankreasleckage nach Pankreasresektion Eine Analyse von 345 operierten Patienten. Chirurg 2002;73:466–473.

    Article  PubMed  CAS  Google Scholar 

  9. Lin JW, Cameron JL, Yeo CJ, Riall TS, Lillemoe KD. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg 2004;8:951–959.

    Article  PubMed  Google Scholar 

  10. Fujino Y, Suzuki Y, Ajiki T, Tanioka Y, Ku Y, Kuroda Y. Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital. Hepatogastroenterology 2002;49:1124–1129.

    PubMed  Google Scholar 

  11. Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg 2005;9:922–927.

    Article  PubMed  Google Scholar 

  12. Okabayashi T, Kobayashi M, Sugimoto T, Namikawa T, Okamoto K, Hokimoto N, Araki K. Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm. Hepatogastroenterology 2004;51:1838–1841.

    PubMed  Google Scholar 

  13. Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW. Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 2003;90:190–196.

    Article  PubMed  CAS  Google Scholar 

  14. Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005;92:539–546.

    Article  PubMed  CAS  Google Scholar 

  15. Abe N, Sugiyama M, Suzuki Y, Yamaguchi Y, Yanagida O, Masaki T, Mori T, Atomi Y. Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg 2006;191:198–200.

    Article  PubMed  Google Scholar 

  16. Sarr MG, The Pancreatic Surgery Group. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 2003;196:556–564.

    Article  PubMed  Google Scholar 

  17. Suc B, Msika S, Piccinini M, Fourtanier G, Hay JM, Flamant Y, Fingerhut A, Fagniez PL, Chipponi J, French Associations for Surgical Research. Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial. Arch Surg 2004;139:288–294.

    Article  PubMed  Google Scholar 

  18. Montorsi M, Zago M, Mosca F, Capussotti L, Zotti E, Ribotta G, Fegiz G, Fissi S, Roviaro G Peracchia A, Pivi M, Perego R, Pezzuoli G. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery 1995;117:26–31.

    Article  PubMed  CAS  Google Scholar 

  19. Buchler M, Friess H, Klempa I, Hermanek P, Sulkowski U, Becker H, Schafmayer A, Baca I, Lorenz D, Meister R, Kremer B, Wagner P, Witte J, Zurmayer EL, Saeger HD, Rieck B, Dollinger P, Glaser K, Teichmann R, Konradt J, Gaus W, Dennler HJ, Welzel D, Beger HG. Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg 1992;163:125–130.

    Article  PubMed  CAS  Google Scholar 

  20. Pederzoli P, Bassi C, Falconi M, Camboni MG. Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Br J Surg 1994;81:265–269.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, P. O. Box 250613, Charleston, SC, 29425, USA

    Thomas Schnelldorfer & David B. Adams

  2. Department of Pharmacy and Clinical Science, Medical University of South Carolina, Charleston, SC, USA

    Patrick D. Mauldin

  3. Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA

    David N. Lewin

Authors
  1. Thomas Schnelldorfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick D. Mauldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David N. Lewin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David B. Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David B. Adams.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schnelldorfer, T., Mauldin, P.D., Lewin, D.N. et al. Distal Pancreatectomy for Chronic Pancreatitis: Risk Factors for Postoperative Pancreatic Fistula. J Gastrointest Surg 11, 991–997 (2007). https://doi.org/10.1007/s11605-007-0187-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0187-y

Keywords

Search

Navigation