An analysis of risk factors for pancreatic fistula after pancreaticoduodenectomy: clinical impact of bile juice infection on day 1.
Langenbecks Arch Surg
; 395(6): 707-12, 2010 Aug.
Article
em En
| MEDLINE
| ID: mdl-19655161
ABSTRACT
BACKGROUND:
Postoperative pancreatic fistula (POPF) is a most striking complication after pancreatic resection. The objective of this study is to reveal the risk factors for POPF defined by the international study group after pancreaticoduodenectomy in a Japanese high-volume center.METHODS:
During the recent 4 years, 220 patients underwent pancreaticoduodenectomies. In patients of obstructive jaundice, preoperative biliary drainage was performed by percutaneous (n = 71) and/or retrograde (n = 38) approach. Pancreaticojejunostomy was performed using either duct-to-mucosa anastomosis (n = 180) or dunking method (n = 40). Risk factors for POPF (grade B or grade C POPF by international definition) were evaluated using univariate and multivariate analyses.RESULTS:
POPF was found in 109 (50%) patients; grade A in 45 (21%), grade B in 54 (25%), and grade C in 10 patients (5%). One patient died of intra-abdominal hemorrhage caused by POPF. Univariate and multivariate analyses revealed that independent risk factors for grade B or grade C POPF were the size of the main pancreatic duct (<3 mm; relative risk (RR), 3.3; p = 0.002), body mass index (> or =20, RR 2.5, p = 0.03), and bile juice infection on day 1 (RR, 2.2; p = 0.04). The performance of biliary drainage or method of pancreaticojejunostomy was not a significant risk factor for POPF. Bile juice infection on day 1 was significantly associated with retrograde biliary drainage (p < 0.001).CONCLUSIONS:
Bile juice infection on day 1 was a significant risk factor for grade B or grade C POPF after pancreaticoduodenectomy. Although the performance or the status of biliary drainage itself was not a risk factor for POPF, percutaneous biliary drainage might be advantageous against retrograde drainage to reduce the risk of biliary infection.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bile
/
Fístula Pancreática
/
Pancreaticoduodenectomia
/
Icterícia Obstrutiva
/
Neoplasias do Sistema Digestório
/
Infecções
Tipo de estudo:
Etiology_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Langenbecks Arch Surg
Ano de publicação:
2010
Tipo de documento:
Article
País de afiliação:
Japão