Surgical management and treatment of pancreatic fistulas

Pancreatic fistulas occur most often as consequences of pancreatic surgery, pancreatitis, and blunt and penetrating pancreatic trauma. Most fistulas heal when treated conservatively. Octreotide has been a valuable addition to the medical regimen that has resulted in lower fistula outputs and earlier closure in many instances. When operative therapy is required, accurate preoperative definition of pancreatic ductal and fistula anatomy is invaluable. Pancreatic resection and internal drainage are both useful procedures-with specific indications and gratifying results. Although octreotide may provide some prophylaxis for postoperative pancreatic fistula development, operative experience and technique are of greater importance.