Management of pancreatic fistulas
F. M. Martin, R. L. Rossi, J. L. Munson, S. G. ReMine and J. W. Braasch
Department of General Surgery, Lahey Clinic Medical Center, Burlington, Mass 01805.
Conservative management of pancreatic fistulas resulting from trauma,
operation for tumor, or operation for pancreatitis has met with variable
success. To assess optimal management strategies and outcome, we reviewed
the records of 35 patients with external pancreatic fistulas (26 patients),
pancreatic ascites (6 patients), or pancreatic pleural effusion (3
patients). Treatment included no operation in 5 patients, oversewing of the
fistula in 7 patients, internal drainage in 11 patients, and resection in
12 patients. One (3%) postoperative death occurred. The overall rate of
operative success was 83% (25 patients). The incidence of recurrent
fistulas was about the same regardless of the procedure. Patients treated
successfully without operation did not have pancreatitis as an underlying
disease. Patient selection is of great importance in the decision to resect
or to drain and is based in part on imaging the pancreatic duct and
fistula.
