Pancreatic fistula after distal pancreatectomy: incidence, risk factors and management

Background: Pancreatic fistulae post distal pancreatectomy still leads to significant morbidity and if not properly managed, may lead to mortality. The identification of risk factors and effective management of patients with pancreatic fistulae is important in the prevention of these complications. Methods: There were 75 open consecutive distal pancreatectomies in the Department of Surgery, Changi General Hospital from May 2001 to May 2007. Results: The indications for operation were neuroendocrine tumours (n = 15), adenocarcinoma (n = 20), Intraductal papillary mucinous tumour (IPMT) (n = 20), serous cysts (n = 15) and trauma (n = 5). There were 20 patients (27%) who developed pancreatic fistulae in the whole series. On univariate analysis, the patients with pancreatic fistulae had significantly more pre-morbidities, softer pancreas and use of staplers as a method of closure of the pancreatic remnant. On multivariate analysis, the use of staplers and soft pancreas were significant independent risk factors for the development of pancreatic fistulae in our patient population. All of the patients with pancreatic fistulae were successfully treated non-surgically with no mortality in the whole series. Conclusions: The use of stapler on soft pancreas leads to a higher risk for pancreatic fistulae after distal pancreatectomies. Most pancreatic fistulae can be managed non-surgically with good outcome.