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World J Gastrointest Surg. 2012 May 27;4(5):114-20. doi: 10.4240/wjgs.v4.i5.114.

Arguments for an individualized closure of the pancreatic remnant after distal pancreatic resection.

Author information

  • 1Ulrich Friedrich Wellner, Frank Makowiec, Olivia Sick, Ulrich Theodor Hopt, Tobias Keck, Department of General and Visceral Surgery, University of Freiburg, 79106 Freiburg, Germany.

Abstract

AIM:

To analyze risk factors for postoperative pancreatic fistula (POPF) rate after distal pancreatic resection (DPR).

METHODS:

We performed a retrospective analysis of 126 DPRs during 16 years. The primary endpoint was clinically relevant pancreatic fistula.

RESULTS:

Over the years, there was an increasing rate of operations in patients with a high-risk pancreas and a significant change in operative techniques. POPF was the most prominent factor for perioperative morbidity. Significant risk factors for pancreatic fistula were high body mass index (BMI) [odds ratio (OR) = 1.2 (CI: 1.1-1.3), P = 0.001], high-risk pancreatic pathology [OR = 3.0 (CI: 1.3-7.0), P = 0.011] and direct closure of the pancreas by hand suture [OR = 2.9 (CI: 1.2-6.7), P = 0.014]. Of these, BMI and hand suture closure were independent risk factors in multivariate analysis. While hand suture closure was a risk factor in the low-risk pancreas subgroup, high BMI further increased the fistula rate for a high-risk pancreas.

CONCLUSION:

We propose a risk-adapted and indication-adapted choice of the closure method for the pancreatic remnant to reduce pancreatic fistula rate.

KEYWORDS:

Body mass index; Distal pancreatic resection; Postoperative pancreatic fistula

PMID:
22655125
[PubMed]
PMCID:
PMC3364336
Free PMC Article

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