CONTEMPORARY TREATMENT STRATEGIES FOR EXTERNAL PANCREATIC FISTULAS

Background. Optimal treatment strategies for patients with external pa ncreatic fistulas have evolved with improved radiographic imaging and the development of transpapillary pancreatic duct stents. The aim of t his study was to examine factors affecting fistula closure and develop a classification scheme to guide therapeutic interventions. Methods. Retrospective chart review was made of all patients with external panc reatic fistulas treated at our institution from January 1991 to Januar y 1997. Side (partial) fistulas maintained continuity with the gastroi ntestinal tract; end (complete) fistulas had no continuity with the ga strointestinal tract. Results. postoperative side fistulas resolved wi th medical treatment in 13 (86%) of 15 patients after a mean of 11 wee ks of conservative management. Inflammatory side fistulas resolved wit h medical treatment in only 8 (53%) of 15 patients after a mean of 22 weeks; those that did not close initially did so with transpapillary s tenting. End pancreatic fistulas never closed with medical treatment a nd were unable to be stented; therefore internal drainage or pancreati c resection was necessary to achieve closure. There were no difference s in sepsis rates, Acute Physiology and Chronic Health Evaluation II s cores, fistula site, total parenteral nutrition, somatostatin treatmen t, or initial fistula output between groups. Conclusions. Classifying external pancreatic fistulas as to their pancreatic duct relationship, and cause provides important prognostic and therapeutic information.