scholarly journals Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Amyna Jiwani ◽  
Tabish Chawla
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Techniques ◽  
Multivisceral Resection ◽  
Postoperative Pancreatic Fistula ◽  
The Body ◽  
Fistula Formation ◽  
Factors Associated

Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

scholarly journals Body Weight at Birth: The Only Risk Factor Associated with Contralateral Clavicular Fracture in Patients with Congenital Muscular Torticollis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Zeeihn Lee ◽  
Joo Young Cho ◽  
Byung Joo Lee ◽  
Jong Min Kim ◽  
Donghwi Park
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Risk Factor ◽  
The Body ◽  
Youden Index ◽  
Clavicular Fracture ◽  
Congenital Muscular Torticollis ◽  
Factors Associated ◽  
Significant Difference ◽  
Muscular Torticollis

Abstract To date and to the best of our knowledge, there have been limited studies on the risk factor of clavicle fracture combined with congenital muscular torticollis (CMT), despite it being the most common fracture in newborns. So, the aim of this study was to investigate the risk factors associated with clavicular fracture combined with CMT, and its effect on prognosis. In this study, a total of 134 infants with CMT were included. The risk factors associated with clavicular fracture combined with CMT were analyzed. To analyze the correlation between the clinical parameters and the clavicular fracture in patients with CMT, demographic data, such as body weight at birth, maternal age, gender, gestational age, delivery method, sternocleidomastoid (SCM) thickness of ipsilateral side, its ratio between the ipsilateral and contralateral side, and the first visitation date after birth were evaluated. In the results of this study, the clavicular fracture was found in 15 of 134 patients with CMT (19%). In multivariate logistic analysis, the body weight at birth was the only significant parameter for predicting clavicular fracture in patients with CMT (p-value < 0.05). However, there was no significant difference of treatment duration between CMT infants with or without clavicular fracture. In infants with CMT, the area under the ROC curve of the body weight at birth for predicting clavicular fracture was 0.659 (95% CI, 0.564–0.745.; p < 0.05). The optimal cut-off value obtained from the maximum Youden index J was 3470 g (sensitivity: 57.14%, specificity: 75.76%), and the odd ratio of clavicular fracture in patients with CMT increased by 1.244 times for every 100 g of body weight at birth. In conclusion, birth weight appears to be a clinical predictor of clavicular fracture in infants with CMT. More studies and discussions are needed on whether any screening should be recommended for detecting the concurrent clavicular fracture in subjects with CMT.

scholarly journals Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy

HPB Surgery ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Fritz Klein ◽  
Igor Maximilian Sauer ◽  
Johann Pratschke ◽  
Marcus Bahra
Keyword(s):  
Bovine Serum Albumin ◽  
Serum Albumin ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Bovine Serum ◽  
Postoperative Mortality ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Formation ◽  
Pancreatic Remnant ◽  
The Impact

Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.

scholarly journals Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study

2021 ◽  
Vol 28 (2) ◽  
pp. 33-45
Author(s):  
E. S. Drozdov ◽  
E. B. Topolnitskiy ◽  
S. S. Klokov ◽  
T. V. Dibina
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Study ◽  
Morphological Examination ◽  
Distal Pancreatic Resection ◽  
Duct Diameter

Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, p < 0.01).Conclusion. A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.

Risk Factors for Postoperative Pancreatic Fistula in Distal Pancreatectomy

2011 ◽  
Vol 58 (109) ◽  
pp. 1372-1376 ◽  
Author(s):  
Koji Soga ◽  
Toshiya Ochiai ◽  
Teruhisa Sonoyama ◽  
Koji Inoue ◽  
Hisashi Ikoma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Postoperative Pancreatic Fistula

scholarly journals Risk factors of postoperative pancreatic fistula after distal pancreatectomy using a triple-row stapler

Surgery Today ◽  
2017 ◽  
Vol 48 (1) ◽  
pp. 95-100 ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Mitsuaki Watanabe ◽  
Naohiro Hosomura ◽  
Hidetake Amemiya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Postoperative Pancreatic Fistula

The risk factors of postoperative pancreatic fistula after distal pancreatectomy

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S127
Author(s):  
Ryutaro Mori ◽  
Ryusei Matsuyama ◽  
Yohei Ota ◽  
Seigo Hiratani ◽  
Koki Goto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Postoperative Pancreatic Fistula

The thickness of pancreatic transection line as a risk factor for postoperative pancreatic fistula after distal pancreatectomy using the stapler

Pancreatology ◽  
2014 ◽  
Vol 14 (3) ◽  
pp. S114
Author(s):  
Akira Muraki ◽  
Satoshi Mizutani ◽  
Takayuki Aimoto ◽  
Seiji Yamagishi ◽  
Ryousuke Nakata ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Transection

A review of methods for preventing pancreatic fistula after distal pancreatectomy

2018 ◽  
Vol 90 (2) ◽  
pp. 38-44
Author(s):  
Katarzyna Mech ◽  
Łukasz Wysocki ◽  
Tomasz Guzel ◽  
Marcin Makiewicz ◽  
Paweł Nyckowski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Techniques ◽  
International Study ◽  
Related Risk ◽  
Number Of Publications ◽  
Definition Of ◽  
Complications And Mortality ◽  
Large Groups

Pancreatic fistula is one of the most severe complications after pancreatic surgeries. The risk of pancreatic fistula after distal pancreatectomy is up to 60%. Effective methods to prevent pancreatic fistula are still sought. A unified definition of pancreatic fistula, which was introduced in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), has allowed for an easier diagnosis and determination of fistula severity, as well as for a reliable inter-center comparison of data. Furthermore, a number of publications point out the risk factors of pancreatic fistula, which may be classified into patient-related risk factors, such as MBI, gender, smoking tobacco or pancreatic structure; and surgery-related risk factors, such as blood loss, prolonged surgery and non-underpinning of the major pancreatic duct. The analysis of risk factors and the use of different methods for the prevention of pancreatic fistula, including novel surgical techniques, may reduce both, the formation and severity of fistula. This will, in turn, lead to reduced secondary complications and mortality, as well as a shorter hospital stay. We present a literature review on different strategies used to prevent pancreatic fistula. It seems, however, that multicenter, prospective, randomized studies in two large groups of patients after pancreatectomy are necessary to establish clear recommendations for the preventive management.

Distal Pancreatectomy for Chronic Pancreatitis: Risk Factors for Postoperative Pancreatic Fistula

2007 ◽  
Vol 11 (8) ◽  
pp. 991-997 ◽  
Author(s):  
Thomas Schnelldorfer ◽  
Patrick D. Mauldin ◽  
David N. Lewin ◽  
David B. Adams
Keyword(s):  
Risk Factors ◽  
Chronic Pancreatitis ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Postoperative Pancreatic Fistula
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