Pancreatic fistula after pancreatic head resection

Background: Pancreatic resections can be performed with great safety. Howev er, the morbidity rate is reported to be 40-60 per cent with a high prevale nce of pancreatic complications. The aim of this study was to analyse compl ications after pancreatic head resection, with particular attention to morb idity and pancreatic fistula. Methods: From November 1993 to May 1999, perioperative and postoperative da ta from 331 consecutive patients undergoing pancreatic head resection were recorded prospectively. Data were analysed and grouped according to the pro cedure performed: classic Whipple resection, pylorus-preserving pancreatodu odenectomy (PPPD) or duodenum-preserving pancreatic head resection (DPPHR). Results: Pancreatic head resection had a mortality rate of 2.1 per cent; th e difference in mortality rate between the three groups (0.9-3.0 per cent) was not significant. Total and local morbidity rates were 38.4 and 28 per c ent respectively. DPPHR had a lower morbidity, both local and systemic, tha n pancreatoduodenectomy. The prevalence of pancreatic fistula was 2.1 per c ent in 331 patients, and was nor dependent on the procedure or the aetiolog y of the disease. Reoperations were performed in 3.9 per cent of patients, predominantly for bleeding and non-pancreatic fistula. None of the patients with pancreatic fistula required reoperation or died in the postoperative course. Conclusion: A standardized technique and a continuing effort to improve per ioperative management may be responsible for low mortality and surgical mor bidity rates after pancreatic head resection. Pancreatic complications occu r with Whipple, PPPD and DPPHR procedures with a similar prevalence. Pancre atic fistula no longer seems to be a major problem after pancreatic head re section and rarely necessitates surgical treatment.