XXXX after pancreaticoduodenectomy: incidence, significance, and management.

@entity1 @entity788 @entity834 @entity86
@entity834 at the pancreaticojejunostomy remains a common and dreaded complication after pancreaticoduodenectomy. Our aim was to determine the incidence, presentation, methods of management, and preoperative and postoperative factors that influence the clinical outcome. We reviewed our collective experience with 375 consecutive @entity1 undergoing pancreaticoduodenectomy from 1980 to 1992 for a variety of pathologic indications. Clinical, biochemical, intraoperative, and postoperative factors were reviewed in an attempt to determine prognostic factors. Sixty-six @entity1 (18%) developed a @entity788 as determined by increased amylase in drainage fluid (44%), radiographic documentation (41%), operative re-exploration (9%), or percutaneous drainage of a peripancreatic, amylase-containing fluid collection (6%). Most leaks (73%) were clinically insignificant and were managed by simple maintenance of intraoperatively placed drains. Active intervention was required in 18 @entity1 (27%) and included percutaneous drainage in 8, completion pancreatectomy in 7, and reoperative drainage with or without anastomotic repair in 3. Although octreotide was used therapeutically in 13 @entity1 (20%), a significant, objective response was noted in only 1 @entity1 . Five (8%) of the 66 @entity1 died, all related directly to the @entity788 . The overall operative mortality was lower, 15 (4%) of 375 @entity1 . Of the clinical, biochemical, intraoperative, and postoperative factors reviewed to determine prognostic factors, only @entity86 predisposed the @entity1 to mortality as a result of the @entity788 . We conclude that most @entity834 at the pancreaticojejunostomy after pancreaticoduodenectomy can be managed conservatively. Use of octreotide to aid in closure of the @entity788 was disappointing, whereas @entity1 with @entity86 or those requiring completion pancreatectomy to manage the @entity834 have increased mortality.
