Outcome of combined pancreatic and biliary fistulas after pancreatoduodenectomy.

Autor:	Aghalarov I; Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany. Electronic address: ilgar.aghalarov@klinikum-bochum.de., Beyer E; Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany., Niescery J; Department of Anesthesiology, St. Josef Hospital, Ruhr University Bochum, Germany., Belyaev O; Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany., Uhl W; Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany., Herzog T; Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Germany.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2023 Jun; Vol. 25 (6), pp. 667-673. Date of Electronic Publication: 2023 Feb 15.
DOI:	10.1016/j.hpb.2023.02.010
Abstrakt:	Background: Postoperative pancreatic fistula (POPF) as well as postoperative biliary fistula (POBF) are considered the main source of postoperative morbidity and mortality after pancreatoduodenectomy (PD). However, little is known about the incidence and complications of combined POPF/POBF compared to isolated POPF or POBF. Methods: This single-center study investigated retrospectively the incidence and postoperative outcome of combined POPF/POBF compared to isolated fistulas following PD in a tertiary German pancreatic center between 2009 and 2018. Results: A total of 678 patients underwent PD for benign and malignant periampullary lesions. Combined fistulas occurred in 6%, isolated POPF in 16%, and isolated POBF in 2%. Pancreatic ductal adenocarcinoma and chronic pancreatitis had a protective effect on the occurrence of combined fistulas, whereas serous cystadenoma and pancreatic metastasis were risk factors. Morbidity (Grade C fistula, post-pancreatectomy hemorrhage, revisional surgery) and mortality was significantly higher in patients with combined fistulas than in those with isolated fistula. Moreover, the duration of ICU stay was longer. Conclusions: A combined POPF/POBF is associated with a significant increase of morbidity and mortality compared to isolated fistulas after PD. Early surgical revision in these patients may improve the postoperative survival rate. (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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