Fístula Pancréatica Tras Operación de Whipple

Current management of pancreatic fistula after pancreaticoduodenectomy
Presented at the 63rd Annual Meeting of the Central Surgical Association, Louisville, Kentucky, March 9-11, 2006.
Gerard V. Aranha MD, FRCS (C), FACSa, b, , , Joshua M. Aaron BSa, Margo Shoup MD, FACSa and Jack Pickleman MD, FACSa aDivision of Surgical Oncology, the Department of Surgery, Loyola University; Stritch School of Medicine, Maywood, IllinoisbGeneral Surgical Service, Hines VA Hospital, Hines, Ill Received 13 February 2006; accepted 13 July 2006. Available online 28 September 2006.
Background
Pancreatic fistula (PF) is a major and serious complication following pancreaticoduodenectomy (PD). The purpose of this study was to outline our management of PF after PD.
Methods
A retrospective review of a prospectively collected database of 396 patients undergoing PD for various indications at Loyola University Medical Center and Hines Veterans Administration Hospital from July 1, 1990, to December 31, 2005. Patients were divided group 1 (no PF) and group 2 (PF). Each group was compared regarding preoperative, intraoperative, and postoperative outcomes.
Results
Of the patients included in the study, 65 patients (16%) developed a PF. PF was more common after PD for ampullary neoplasms (28%), duodenal neoplasms (35%), and serous cystic neoplasms (44%), and was uncommon after PD for pancreatic cancer (6%). Associated complications with PF was 51% when compared with patients with no PF (21%; P ≤ .001). Duration of hospital stay was 16 days in PF versus 9 days in no PF (≤.001). Intraoperative blood loss was greater in the PF versus no PF group (P = .01). Clinically serious postoperative complications in the PF versus no PF group were mortality (P = .03), intraabdominal abscess (P ≤ .001), wound infection (P ≤ .001), hemorrhage (P = .01), cardiac (P ≤ .001), bile leak (P ≤ .001), and reoperation (P = .02). Of the 62 surviving patients with PF, 36 (58%) were treated with maintenance of oral diet, 25 (40%) with parenteral nutrition, and 1 (1.6%) required surgery for closure of PF.
Conclusions
PF is a serious complication after PD and is associated with substantial mortality and other complications. The majority of patients with PF can be managed conservatively with either maintenance of oral diet or parenteral nutrition until closure of the PF.