[The management of postoperative pancreatic fistulas]

Postoperative pancreatic fistula is the most common major complication after pancreatic surgery and it can lead to prolonged hospital stay, increased costs and mortality. Its incidence is between 2 and 30%. We present a series of 100 successive patients, operated in our clinic for different pancreatic diseases. Among them, 21 had pancreaticoduodenectomies, 24- enucleation procedures for insulinomas or pancreatic adenomas, 31- distal pancreato-spleenectomies and in 24 cases a pancreatic abcess or pseudocyst was drained. A pancreatic fistula occurred in 21 patients (21%); we analyzed the treatment and outcome of these fistulas, according to our experience and to the International Study Group of Pancreatic Fistula (ISGPF) classification. 10 patients needed only medical treatment, while in 11 cases one/more new surgical procedure(s) was/were required. 15 patients had a favourable evolution and 6 other patients deceased. In persistent fistulas, as well as in those with a high output, the resection of the pancreatic remnant appears to be the best surgical option.