Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management

American Journal of Surgery
J J CullenD M Ilstrup

Abstract

Anastomotic leak at the pancreaticojejunostomy remains a common and dreaded complication after pancreaticoduodenectomy. Our aim was to determine the incidence, presentation, methods of management, and preoperative and postoperative factors that influence the clinical outcome. We reviewed our collective experience with 375 consecutive patients undergoing pancreaticoduodenectomy from 1980 to 1992 for a variety of pathologic indications. Clinical, biochemical, intraoperative, and postoperative factors were reviewed in an attempt to determine prognostic factors. Sixty-six patients (18%) developed a pancreatic anastomotic leak as determined by increased amylase in drainage fluid (44%), radiographic documentation (41%), operative re-exploration (9%), or percutaneous drainage of a peripancreatic, amylase-containing fluid collection (6%). Most leaks (73%) were clinically insignificant and were managed by simple maintenance of intraoperatively placed drains. Active intervention was required in 18 patients (27%) and included percutaneous drainage in 8, completion pancreatectomy in 7, and reoperative drainage with or without anastomotic repair in 3. Although octreotide was used therapeutically in 13 patients (20%), a significant, objectiv...Continue Reading

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