Risk analysis of pancreatic fistula after pancreatic head resection

Objective: To evaluate the risk factors for pancreatic fistula after pancreatic head resection. Design: Retrospective review. Setting: University hospital, in the 71-month period from January 1992 through November 1997. Patients and intervention: Sixty-two patients who underwent pancreatic head resection with pancreatojejunostomy. We performed an extensive analysis of preoperative and perioperative risk factors for pancreatic fistula. Main Outcome Measures: Pancreatic fistula was defined as high amylase level (>1000 U/L) in the drainage fluid collected from the peripancreatic drains and/or anastomotic disruption demonstrated radiographically. Results: Nine (15%) of the 62 patients developed pancreatic fistula, and 1 (1.6%) died of intra-abdominal hemorrhage related to the pancreatic fistula. A preoperative normal N-benzoyl-L-tyrosyl-p-aminobenzoic acid test result (P=.01), soft or intermediate pancreatic consistency (P=.04), duodenum-preserving pancreatic head resection for the normal exocrine pancreas (P=.002), and a larger amount of postoperative pancreatic juice output (P=.02) were significant risk factors for pancreatic fistula formation. Conclusions: Careful attention should be paid to the preoperative exocrine pancreatic function, pancreatic consistency at surgery, and postoperative pancreatic juice output to predict and prevent pancreatic fistula after pancreatic head resection.