Postoperative Pancreatic Fistulas
2008; Lippincott Williams & Wilkins; Volume: 249; Issue: 1 Linguagem: Inglês
10.1097/sla.0b013e31819274fe
ISSN1528-1140
AutoresSergio Pedrazzoli, G Liessi, Claudio Pasquali, Roberto Ragazzi, Mattia Berselli, Cosimo Sperti,
Tópico(s)Gallbladder and Bile Duct Disorders
ResumoPostoperative 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.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.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.Early aggressive interventional radiology allowed managing conservatively 95.7% of POPF preventing severe complications and avoiding death.
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