Pancreatic fistula formation after pancreaticooduodenectomy; for prevention of this deep surgical site infection after pancreatic surgery.

BACKGROUND/AIMS: The operative mortality and morbidity associated with pancreatoduodenectomy (PD) has been decreasing, however, pancreatic fistula remains a major cause of a potentially fatal complication. The aim of this study was to identify risk factors, predictors and prevention for pancreatic fistula formation in a consecutive series of PD cases in a single institution.

METHODOLOGY: The association between pancreatic fistula formation and various clinical parameters was investigated in 100 patients who underwent PD at Kochi Medical School from April 1999 through December 2007.

RESULTS: The incidence of pancreatic fistula in these patients was 18%. Multivariate analysis identified 4 independent parameters correlating with occurrence of pancreatic fistula: (1) no use with ultrasonically activated scalpel on the pancreatic transaction (odds ratio, 2.1; 95% confidence interval, 1.2-3.8; p = 0.001); (2) no performance with duct-to-mucosa anastomosis for pancreatico-enteric reconstruction (4.3; 1.1-16.1; p = 0.006); (3) not having early postoperative enteral nutrition through the jejunostomy catheter (2.3; 1.1-5.0; p = 0.007); and (4) serum amylase concentration greater than 194 U/L (1.7 times the normal upper limit) on the first postoperative day (2.0; 1.1-3.9; p = 0.019).

CONCLUSION: The current study suggested that the reconstruction of duct-to-mucosa anastomosis for pancreatico-jejunostomy by using the ultrasonically activated scalpel and the use of early postoperative enteral nutrition should be attempted as a means to reduce the incidence of pancreatic fistula after PD.