Pancreatic fistula rates after 462 distal pancreatectomies

Staplers do not decrease fistula rates

Cristina R. Ferrone, Andrew L. Warshaw, David W. Rattner, David Berger, Hui Zheng, Bhupendra Rawal, Ruben Rodriguez, Sarah P Thayer, Carlos Fernandez-Del Castillo

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

Introduction: Pancreatic fistula is a major source of morbidity after distal pancreatectomy (DP). We reviewed 462 consecutive patients undergoing DP to determine if the method of stump closure impacted fistula rates. Methods: A retrospective review of clinicopatologic variables of patients who underwent DP between February 1994 and February 2008 was performed. The International Study Group classification for pancreatic fistula was utilized (Bassi et al., Surgery, 138(1):8-13, 2005). Results: The overall pancreatic fistula rate was 29% (133/462). DP with splenectomy was performed in 321 (69%) patients. Additional organs were resected in 116 (25%) patients. The pancreatic stump was closed with a fish-mouth suture closure in 227, of whom 67 (30%) developed a fistula. Pancreatic duct ligation did not decrease the fistula rate (29% vs. 30%). A free falciform patch was used in 108 patients, with a fistula rate of 28% (30/108). Stapled compared to stapled with staple line reinforcement had a fistula rate of 24% (10/41) vs. 33% (15/45). There is no significant difference in the rate of fistula formation between the different stump closures (p=0.73). On multivariate analysis, BMI>30 kg/m2, male gender, and an additional procedure were significant predictors of pancreatic fistula. Conclusions: The pancreatic fistula rate was 29%. Staplers with or without staple line reinforcement do not significantly reduce fistula rates after DP. Reduction of pancreatic fistulas after DP remains an unsolved challenge.

Original languageEnglish (US)
Pages (from-to)1691-1697
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume12
Issue number10
DOIs
StatePublished - Oct 1 2008

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Pancreatic Fistula
Pancreatectomy
Fistula
Pancreatic Ducts
Splenectomy
Sutures
Ligation
Mouth
Fishes
Multivariate Analysis
Morbidity

Keywords

  • Distal pancreatectomy
  • Pancreatic fistula

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Ferrone, C. R., Warshaw, A. L., Rattner, D. W., Berger, D., Zheng, H., Rawal, B., ... Fernandez-Del Castillo, C. (2008). Pancreatic fistula rates after 462 distal pancreatectomies: Staplers do not decrease fistula rates. Journal of Gastrointestinal Surgery, 12(10), 1691-1697. https://doi.org/10.1007/s11605-008-0636-2

Pancreatic fistula rates after 462 distal pancreatectomies : Staplers do not decrease fistula rates. / Ferrone, Cristina R.; Warshaw, Andrew L.; Rattner, David W.; Berger, David; Zheng, Hui; Rawal, Bhupendra; Rodriguez, Ruben; Thayer, Sarah P; Fernandez-Del Castillo, Carlos.

In: Journal of Gastrointestinal Surgery, Vol. 12, No. 10, 01.10.2008, p. 1691-1697.

Research output: Contribution to journalArticle

Ferrone, CR, Warshaw, AL, Rattner, DW, Berger, D, Zheng, H, Rawal, B, Rodriguez, R, Thayer, SP & Fernandez-Del Castillo, C 2008, 'Pancreatic fistula rates after 462 distal pancreatectomies: Staplers do not decrease fistula rates', Journal of Gastrointestinal Surgery, vol. 12, no. 10, pp. 1691-1697. https://doi.org/10.1007/s11605-008-0636-2
Ferrone, Cristina R. ; Warshaw, Andrew L. ; Rattner, David W. ; Berger, David ; Zheng, Hui ; Rawal, Bhupendra ; Rodriguez, Ruben ; Thayer, Sarah P ; Fernandez-Del Castillo, Carlos. / Pancreatic fistula rates after 462 distal pancreatectomies : Staplers do not decrease fistula rates. In: Journal of Gastrointestinal Surgery. 2008 ; Vol. 12, No. 10. pp. 1691-1697.
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abstract = "Introduction: Pancreatic fistula is a major source of morbidity after distal pancreatectomy (DP). We reviewed 462 consecutive patients undergoing DP to determine if the method of stump closure impacted fistula rates. Methods: A retrospective review of clinicopatologic variables of patients who underwent DP between February 1994 and February 2008 was performed. The International Study Group classification for pancreatic fistula was utilized (Bassi et al., Surgery, 138(1):8-13, 2005). Results: The overall pancreatic fistula rate was 29{\%} (133/462). DP with splenectomy was performed in 321 (69{\%}) patients. Additional organs were resected in 116 (25{\%}) patients. The pancreatic stump was closed with a fish-mouth suture closure in 227, of whom 67 (30{\%}) developed a fistula. Pancreatic duct ligation did not decrease the fistula rate (29{\%} vs. 30{\%}). A free falciform patch was used in 108 patients, with a fistula rate of 28{\%} (30/108). Stapled compared to stapled with staple line reinforcement had a fistula rate of 24{\%} (10/41) vs. 33{\%} (15/45). There is no significant difference in the rate of fistula formation between the different stump closures (p=0.73). On multivariate analysis, BMI>30 kg/m2, male gender, and an additional procedure were significant predictors of pancreatic fistula. Conclusions: The pancreatic fistula rate was 29{\%}. Staplers with or without staple line reinforcement do not significantly reduce fistula rates after DP. Reduction of pancreatic fistulas after DP remains an unsolved challenge.",
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