Pancreatic anastomosis leakage management following pancreaticoduodenectomy how could be manage the anastomosis leakage after pancreaticoduodenectomy?

Abstract

Background: Pancreatic anastomosis leakage and fistula formation following  pancreaticoduodenectomy (Whipple’s procedure) is a common complication. Delay in timely diagnosis and proper management is associated with high morbidity and mortality. To report our experience with management of pancreatic fistula following Whipple’s procedure. Materials and Methods: In this retrospective study, medical records of 90 patients who underwent Whipple’s procedure from 2009 to 2013 at our medical center were reviewed for documents about pancreatic anastomosis leakage and fistula formation. Results: There were 15 patients who developed pancreaticojejunal anastomosis leakage. In 6 patients (3 males and 3 females) the leakage was mild (conservative therapy was administered), but in 9 patients (6 males and 3 females), there was severe leakage. For the latter group, surgical intervention was done (2 cases underwent re-anastomosis and for 7 cases pancreatico-jejunal stump ligation was done along with drainage of the location). Conclusion: In severe pancreatic anastomotic leakage, it is better to intervene surgically as soon as possible by debridement of the distal part of the pancreas and ligation of the stump with nonabsorbable suture. Furthermore, debridement of the jejunum should be done, and the stump should be ligated thoroughly along with drainage.

Key words: Anastomostic leakage, debridement, pancreas, pancreaticoduodenectomy, stump ligation