Prevention of pancreatic fistulae after surgical resection: a decade of clinical trials

Prevention of fistula formation Pancreatic fistulae occur in about 10-20% o f patients undergoing pancreaticoduodenectomy and are a leading cause of mo rbidity. We reviewed trials devoted to prevention. Surgical procedures for reduction of pancreatic secretion and modification of the remnant pancreas could be useful as preventive measures. Innovating surgery Several surgical procedures have been proposed to decrea se the rate of complications, but none have demonstrated efficacy in a pros pective randomized trial. Pancreatogastrostomy (PG) or pancreatojejuneostom y (PJ) have been compared in nine studies: seven retrospective series and t wo prospective randomized trials. The one trial using a correct randomizati on method found equivalent early results for PC and PJ. Inhibitors of pancreas secretion Eleven randomized trials have assessed the use of somatostatin or octreotide for the prevention of fistulae after pan creaticoduodenectomy. There has been significant heterogenity in these tria ls concerning the definition of fistula, dosage of octreotide, starting tim e and duration of treatment. Six studies have concluded that these drugs ar e effective while 5 concluded that there is no significant difference. Perspectives There is no convincing argument to affirm the superiority of P C or PJ. For the present, the use of somatostatin or octreotide cannot be r ecommended in routine practice for the prevention of postoperative complica tions of pancreatic surgery.