The pancreatic stump after pancreatoduodenectomy: the "Achille's heel" revisited

Pancreatic fistula, the most dreaded complication of pancreatoduodenectomy occurs with an incidence ranging from 4-30% in literature reports; the incidence varies considerably according to the definition of fistula used. This literature review describes various methods proposed over the last decade to decrease the incidence and severity of pancreatic fistula including techniques of pancreatico-jejunal and pancreatico-gastric anastomoses, deliberate avoidance of pancreatico-enteric anastomosis, and the prophylactic role of somatostatin analogues.