Pancreatic anastomotic failure after pancreaticoduodenectomy

BACKGROUND: Pancreatic anastomotic failure has historically been regarded a s one of the most feared complications after pancreaticoduodenectomy. METHODS: We reviewed our recent experience (59 cases), March 1994 to Decemb er 1998, with pancreaticoduodenectomy and compared preoperative and intraop erative characteristics as well as outcomes in those patients who experienc ed (n = 10) versus those who did not experience a postoperative pancreatic leak (n = 49). Information was retrospectively collected from hospital reco rds, office records, and interviews with patients. RESULTS: The clinical leak rate in this series was 8.5%. There were no sign ificant differences in preoperative or intraoperative characteristics compa ring those with versus those without a postoperative pancreatic leak. Only 1 of 10 patients with a postoperative pancreatic leak required reoperation to manage the leak. Those with a pancreatic leak had more other postoperati ve complications (median 2 versus 0 complications per patient, P = 0.01) an d longer hospital duration compared with those without a leak (median 13 ve rsus 23 days, P <0.01). Overall mortality in the series was 3.4%; no mortal ities occurred as a result of a pancreatic leak. CONCLUSIONS: In the 1990s pancreatic anastomotic leak remains a potentially lethal problem after pancreaticoduodenectomy. Pancreatic leakage after pan creaticoduodenectomy is associated with other postoperative complications a nd a longer hospital stay. Am J Surg. 2000; 180:117-120. (C) 2000 by Excerp ta Medica, Inc.