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The Massachusetts General Hospital Experience

Gregory Veillette, MD; Ismael Dominguez, MD; Cristina Ferrone, MD; Sarah P. Thayer, MD, PhD; Deborah McGrath, RN; Andrew L. Warshaw, MD; Carlos Fernández-del Castillo, MD

Arch Surg. 2008;143(5):476-481.

Objective  To describe the management and impact of pancreatic fistulas in a high-volume center.

Design  Retrospective case series.

Setting  Tertiary academic center.

Patients  Five hundred eighty-one consecutive patients who underwent pancreaticoduodenectomy from January 2001 through June 2006.

Main Outcome Measures  Development of a pancreatic fistula (defined as > 30 mL of amylase-rich fluid from drains on or after postoperative day 7, or discharge with surgical drains in place, regardless of amount); the need for additional interventions or total parenteral nutrition; other morbidity; and mortality.

Results  Seventy-five patients (12.9%) developed a pancreatic fistula. Fistulas were managed with gradual withdrawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas. The remaining 46 patients (61.3%) had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding; these were classified as high-impact fistulas and closed a mean of 35 days after surgery. Standard 30-day in-hospital mortality was 1.9% for all pancreaticoduodenectomies and 6.7% for those who developed a pancreatic fistula. The overall fistula-related mortality was 9.3% (7 patients), all but 1 of which was related to major hemorrhage.

Conclusions  More than one-third of pancreatic fistulas are clinically insignificant (low impact). The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality.

Author Affiliations: Department of Surgery, Massachusetts General Hospital, Boston.

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RELATED LETTERS

Clinically Significant Pancreatic Fistulas
Tetsuji Fujita
Arch Surg. 2008;143(11):1132.
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Clinically Significant Pancreatic Fistulas—Reply
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