Critical Appraisal of 232 Consecutive Distal Pancreatectomies With Emphasis on Risk Factors, Outcome, and Management of the Postoperative Pancreatic Fistula

Abstract

In recent times, advances in operative technique and the perioperative care of patients have resulted in a low mortality rate for distal pancreatectomy (DP) as reported by several recent large series.^1-6 However, the morbidity rates have remained high, ranging from 22% to 47%.^4,6-9 The pancreatic fistula (PF) has consistently been reported as the most common complication after DP.^4-6 Although frequently of clinical inconsequence, it may result in numerous clinically significant and potentially life-threatening complications, such as intra-abdominal abscess, intra-abdominal hemorrhage, wound infection, and sepsis,⁶ which often translate to a significant increase in hospitalization costs.⁷ The present report critically analyzes a large single-institution experience with DP, with particular attention to risk factors contributing to postoperative PF formation, its subsequent clinical sequelae, and its management.