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Norihiro Sato, MD; Koji Yamaguchi, MD; Kazuo Chijiiwa, MD; Masao Tanaka, MD

Arch Surg. 1998;133:1094-1098.

Objective  To evaluate the risk factors for pancreatic fistula after pancreatic head resection.

Design  Retrospective review.

Setting  University hospital, in the 71-month period from January 1992 through November 1997.

Patients and Intervention  Sixty-two patients who underwent pancreatic head resection with pancreatojejunostomy. We performed an extensive analysis of preoperative and perioperative risk factors for pancreatic fistula.

Main Outcome Measures  Pancreatic fistula was defined as high amylase level (>1000 U/L) in the drainage fluid collected from the peripancreatic drains and/or anastomotic disruption demonstrated radiographically.

Results  Nine (15%) of the 62 patients developed pancreatic fistula, and 1 (1.6%) died of intra-abdominal hemorrhage related to the pancreatic fistula. A preoperative normal N -benzoyl-L-tyrosyl-p-aminobenzoic acid test result (P=.01), soft or intermediate pancreatic consistency (P=.04), duodenum-preserving pancreatic head resection for the normal exocrine pancreas (P=.002), and a larger amount of postoperative pancreatic juice output (P=.02) were significant risk factors for pancreatic fistula formation.

Conclusions  Careful attention should be paid to the preoperative exocrine pancreatic function, pancreatic consistency at surgery, and postoperative pancreatic juice output to predict and prevent pancreatic fistula after pancreatic head resection.

From the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.

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