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Review
. 2022 Aug;38(4):233-242.
doi: 10.1159/000521727. Epub 2022 Mar 2.

Surgical Management of Postoperative Grade C Pancreatic Fistula following Pancreatoduodenectomy

Orlando Jorge Martins Torres  1 , José Maria Assunção Moraes-Junior  1 , Eduardo de Souza Martins Fernandes  2 , Thilo Hackert  3
Affiliations
Review

Surgical Management of Postoperative Grade C Pancreatic Fistula following Pancreatoduodenectomy

Orlando Jorge Martins Torres et al. Visc Med. 2022 Aug.

Abstract

Background: The incidence of Grade C postoperative pancreatic fistula ranges from 2 to 11% depending on the type of pancreatic resection. This complication may frequently require early relaparotomy and the surgical approach remains technically challenging and is still associated with a high mortality. Infectious complications and post-operative hemorrhage are the two most common causes of reoperation.

Summary: The best management of grade C pancreatic fistulas remains controversial and ranges from conservative approaches up to completion pancreatectomy. The choice of the technique depends on the patient's conditions, intraoperative findings, and surgeon's discretion. A pancreas-preserving strategy appears to be attractive, including from simple to more complex procedures such as debridement and drainage, and external wirsungostomy. Completion pancreatectomy should be reserved for selected cases, including stable patients with severe infection complication or hemorrhage after pancreatic fistula who do not respond to pancreas-preserving procedures.

Key messages: This review describes the current options for management of grade C pancreatic fistula after pancreatoduodenectomy with regard to indication, choice of procedure and outcomes of the different approaches.

Keywords: Grade C fistula; Pancreatic fistula; Pancreatoduodenectomy; Postoperative pancreatic fistula; Surgical management; Whipple.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Debridement and drainage of grade C pancreatic fistula.
Fig. 2
Fig. 2
a Main pancreatic duct occlusion. b Wirsungography. c Pancreatic duct occlusion with cyanoacrylate.
Fig. 3
Fig. 3
a External wirsungostomy. b Stent into the pancreatic duct. c External drainage.
Fig. 4
Fig. 4
Internal wirsungostomy.
Fig. 5
Fig. 5
Salvage pancreatogastrostomy.
Fig. 6
Fig. 6
Completion pancreatectomy.
See this image and copyright information in PMC

References

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