Risk factors associated with pancreatic fistula after distal pancreatectomy

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Amin Makni
Wael Rebai
Amin Daghfouss
Sofiene Ayadi
Fadhel Fterich
Faouzi Chebbi
Rachid Ksantini
Mohamed Jouini
Montassar Kacem
Zoubeir Ben Safta

Abstract

Background: Pancreatic leak (PL) remains a major cause of postoperative morbidity in patients undergoing pancreatic resection.
Aim: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP).
Methods: 35 patients underwent DP during a 10-year period (2000- 2009). Informations regarding diagnosis, operative details, and perioperative morbidity and mortality were collected. Nine risk factors were examined. Results: Indications for DP included primary pancreatic disease (n=23; 66 %) and non-pancreatic disease (n = 12; 34 %). Postoperative morbidity rate was 43 % and none patient died. No patients required a reoperation. Pancreatic fistula was occurred in 11 patients (31 %). On univariate analysis, incidence of pancreatic fistula rate was not significantly associated with these risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, additional procedures, intra operative bleeding and texture of pancreatic parenchyma. We observed significant statistical difference between male and female, 47 % of females experienced a pancreatic fistula, while 17 % males developed a pancreatic leakage (p =0.05). The role of the technique of pancreatic stump closure in the development of pancreatic leak remains unclear because of the few number of patients on who we used stapler.
Conclusion: The rate of pancreatic fistula after left pancreatectomy is 31 %. The female was identified as a risk factor for occurrence of pancreatic fistula after left pancreatectomy. The role implicated in the use of a mechanical claw for the treatment of pancreatic stump requires a larger number of patients to conclude. The body mass index has not been studied in our series.

Keywords:

Pancreatectomy- pancreatic- fistula- left pancreatectomy

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