ORIGINAL ARTICLES   

Minerva Chirurgica 2008 June;63(3):199-207

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: Italian

Pancreatic fistula after left pancreatectomy. Risk factors analysis on 68 patients

Pericoli Ridolfini M. ¹, Alfieri S. ², Gourgiotis S. ³, Di Miceli D. ², Quero G. ², Rotondi F. ², Caprino P. ¹, Sofo L. ¹, Doglietto B. G. ²

¹ Dipartimento di Chirurgica Oncologica Università Cattolica del Sacro Cuore Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche “Giovanni Paolo II”, Campobasso, Italia 2 Dipartimento di Scienze Chirurgiche Unità di Chirurgia Digestiva Università Cattolica del Sacro Cuore Policlinico “A. Gemelli”, Roma, Italia 3 Dipartimento di Chirurgia Epatobiliare e Pancreatica Royal London Hospital Londra, Regno Unito

Aim. The aim of this study was to identify risk factors related to pancreatic fistula after left pancreatectomy, considering the difference between the use of mechanical suture and the manual suture to close the pancreatic stump.
Methods. Sixty-eight patients, undergoing left pancreatectomy, were included in this study during a 10-year period. Eight possible risk factors related to pancreatic fistula were examined, such as demographic data (age and sex), pathology (pancreatic and extrapancreatic), technical characteristics (stump closure, concomitant splenectomy, additional procedures), texture of pancreatic parenchyma, octreotide therapy.
Results. Fourty-one patients (60%) underwent left pancreatectomy for primary pancreatic disease and 27 (40%) for extrapancreatic malignancy. Postoperative mortality and morbidity rates were 1.5% and 35%, respectively. Fourteen patients (20%) developed pancreatic fistula: 4 of them were classified as Grade A, 9 as Grade B and only one as Grade C. Three factors have been significantly associated to the incidence of pancreatic fistula: none prophylactic octreotide therapy, spleen preserving and soft pancreatic texture. It’s still unclear the influence of pancreatic stump closure (stapler vs hand closure) in the onset of pancreatic fistula.
Conclusion. In this study the incidence of pancreatic fistula after left pancreatectomy has been 20%. This rate is lower for patients with fibrotic pancreatic tissue, concomitant splenectomy and postoperative prophylactic octreotide therapy.