Korean J Hepatobiliary Pancreat Surg.  2011 Nov;15(4):243-247. 10.14701/kjhbps.2011.15.4.243.

Complication analysis of distal pancreatectomy based on early personal experience

Affiliations
  • 1Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea. seohi71@hanmail.net

Abstract

BACKGROUNDS/AIMS
The objective of this study was to evaluate the relationship between initial personal experiences with distal pancreatectomy and perioperative risk factors, outcomes, and management of pancreatic fistulas.
METHODS
Between May, 2007 and May, 2010, a total of 28 patients who had undergone elective distal pancreatectomy were evaluated for this study. Perioperative factors and the occurrence of pancreatic fistula were analyzed on the basis of International Study Group of Pancreatic Fistula (ISGPF) criteria.
RESULTS
There were sixteen cases of benign neoplasms and twelve cases of malignant tumors. The remnant pancreas was manually sutured with ligation of the pancreatic duct (n=14), auto-suture stapling along with manual sutures (n=12), or stapling alone (n=2). According to the ISGPF classification, morbidity and mortality associated with pancreatic fistulas was 42.9% (n=12) and 0%, respectively. These pancreatic fistulae were classified as grade A in 8 cases (28.6%), grade B in 3 cases (10.7%), and grade C in one case (3.6%). All patients with pancreatic fistula were treated conservatively.
CONCLUSIONS
Perioperative factors do not affect the risk of pancreatic fistula. Adequate drainage is the most effective method for management of a pancreatic fistula after distal pancreatectomy.

Keyword

Distal pancreatectomy; Pancreatic fistula; Complication; Leak

MeSH Terms

Drainage
Humans
Ligation
Pancreas
Pancreatectomy
Pancreatic Ducts
Pancreatic Fistula
Risk Factors
Sutures

Reference

1. Kim HS, Jo HJ, Jeon TY, Sim MS. Factors influencing the pancreatic leakage after pancreaticoduodenectomy. Korean J Hepatobiliary Pancreat Surg. 2001; 5:147–154.
2. Harris LJ, Abdollahi H, Newhook T, et al. Optimal technical management of stump closure following distal pancreatectomy: a retrospective review of 215 cases. J Gastrointest Surg. 2010; 14:998–1005. PMID: 20306151.
Article
3. Ferrone CR, Warshaw AL, Rattner DW, et al. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 2008; 12:1691–1697. PMID: 18704597.
Article
4. Yoshioka R, Saiura A, Koga R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg. 2010; 34:121–125. PMID: 20020297.
Article
5. Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987; 206:358–365. PMID: 3632096.
Article
6. Fernández-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg. 1995; 130:295–299. PMID: 7887797.
Article
7. Aldridge MC, Williamson RC. Distal pancreatectomy with and without splenectomy. Br J Surg. 1991; 78:976–979. PMID: 1913121.
Article
8. Kelly KJ, Greenblatt DY, Wan Y, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011; 15:250–259. PMID: 21161427.
Article
9. Sledzianowski JF, Duffas JP, Muscari F, Suc B, Fourtanier F. Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery. 2005; 137:180–185. PMID: 15674199.
Article
10. Bassi C, Dervenis C, Butturini G, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138:8–13. PMID: 16003309.
Article
11. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007; 245:443–451. PMID: 17435552.
Article
12. Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg. 2008; 32:419–428. PMID: 18175170.
Article
13. Nathan H, Cameron JL, Goodwin CR, et al. Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg. 2009; 250:277–281. PMID: 19638926.
Article
14. Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg. 2008; 143:956–965. PMID: 18936374.
15. Zhou W, Lv R, Wang X, Mou Y, Cai X, Herr I. Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg. 2010; 200:529–536. PMID: 20538249.
Article
16. Seeliger H, Christians S, Angele MK, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg. 2010; 200:311–317. PMID: 20381788.
Article
17. Sheehan MK, Beck K, Creech S, Pickleman J, Aranha GV. Distal pancreatectomy: does the method of closure influence fistula formation? Am Surg. 2002; 68:264–267. PMID: 11893105.
18. Kajiyama Y, Tsurumaru M, Udagawa H, Tsutsumi K, Kinoshita Y, Akiyama H. Quick and simple distal pancreatectomy using the GIA stapler: report of 35 cases. Br J Surg. 1996; 83:1711. PMID: 9038547.
Article
19. Takeuchi K, Tsuzuki Y, Ando T, et al. Distal pancreatectomy: is staple closure beneficial? ANZ J Surg. 2003; 73:922–925. PMID: 14616571.
Article
20. 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. PMID: 12555295.
Article
21. Nakamura Y, Uchida E, Aimoto T, Matsumoto S, Yoshida H, Tajiri T. Clinical outcome of laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2009; 16:35–41. PMID: 19083146.
Article
22. Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg. 2002; 183:237–241. PMID: 11943118.
Article
Full Text Links
  • KJHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr