Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy: A comparison of different surgical strategies

Gianpaolo Balzano, Nicolò Pecorelli, Lorenzo Piemonti, Riccardo Ariotti, Michele Carvello, Rita Nano, Marco Braga, Carlo Staudacher

Research output: Contribution to journalArticle

Abstract

Introduction A relaparotomy for a pancreatic fistula (PF) after a pancreaticoduodenectomy (PD) is a formidable operation, and the appropriate treatment of anastomotic leakage is under debate. The objective of this study was to compare the outcomes of different strategies in managing the pancreatic remnant during a relaparotomy for PF after a PD. Methods In this retrospective study on prospectively collected data, 669 PD were performed between 2004 and 2011. The study group comprised 31 patients requiring a relaparotomy, because of delayed haemorrhage (n = 19) or sepsis (n = 12). The pancreatic stump was treated either using pancreas-preserving techniques (simple drainage or duct occlusion) or completion of a pancreatectomy (CP). In 2008, autologous islet transplantation (AIT) was introduced for endocrine tissue rescue of CP. Results The mortality rate, blood loss and transfusion requirement were similar for all techniques. Patients undergoing a CP required a further relaparotomy less frequently than patients with pancreas preservation (7% versus 59%, P <0.01), and the intensive care unit (ICU) stay was reduced after CP (P = 0.058). PF persisted at discharge in 66% of patients after pancreas-preserving techniques. AIT was associated with CP in 7 patients, of whom one died post-operatively. Long-term graft function was maintained in four out of six surviving patients, with one insulin-independent patient at 36 months after transplantation. Conclusions When a PF requires a relaparotomy, CP has become our favoured technique. AIT can reduce the metabolic impact of the procedure.

Original languageEnglish
Pages (from-to)40-45
Number of pages6
JournalHPB
Volume16
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Pancreatic Fistula
Pancreaticoduodenectomy
Pancreatectomy
Islets of Langerhans Transplantation
Autologous Transplantation
Pancreas
Anastomotic Leak
Blood Transfusion
Intensive Care Units
Drainage
Sepsis
Retrospective Studies
Transplantation
Insulin
Hemorrhage
Transplants
Mortality

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy : A comparison of different surgical strategies. / Balzano, Gianpaolo; Pecorelli, Nicolò; Piemonti, Lorenzo; Ariotti, Riccardo; Carvello, Michele; Nano, Rita; Braga, Marco; Staudacher, Carlo.

In: HPB, Vol. 16, No. 1, 01.2014, p. 40-45.

Research output: Contribution to journalArticle

Balzano, Gianpaolo ; Pecorelli, Nicolò ; Piemonti, Lorenzo ; Ariotti, Riccardo ; Carvello, Michele ; Nano, Rita ; Braga, Marco ; Staudacher, Carlo. / Relaparotomy for a pancreatic fistula after a pancreaticoduodenectomy : A comparison of different surgical strategies. In: HPB. 2014 ; Vol. 16, No. 1. pp. 40-45.
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