Pancreatic fistula primary prevention: Difference between revisions
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== Overview == | |||
[[Pancreatic fistula]] is a known complication following a [[pancreatic]] surgery. Post operation management is focused towards prevention of complications arising as a consequence of [[pancreatic]] secretion from an anastomotic stump or the surface of [[skin]] which can subsequently complicate into intraabdominal abscess formation or life threatening hemorrhage. To reduce the risk of development of a post-operative [[pancreatic fistula]], [[prophylactic]] measures such as [[nutrition]] support, [[prophylactic]] [[somatostatin]] analogues, [[Drain (surgery)|drain]] management and a post-operation follow up is taken to reduce the risk of [[pancreatic fistula]] formation. | |||
== Primary prevention == | |||
[[Pancreatic fistula]] is a known complication following a [[pancreatic]] surgery. Post-operation management is focused towards prevention of complications arising as a consequence of [[pancreatic]] secretion from an [[anastomotic]] stump or the surface of [[skin]] which can subsequently complicate into intraabdominal [[abscess]] formation or life threatening [[hemorrhage]]. To reduce the risk of development of a post-operative [[pancreatic fistula]], the following [[prophylactic]] measures are taken:<ref name="pmid31391768">{{cite journal| author=Kawaida H, Kono H, Hosomura N, Amemiya H, Itakura J, Fujii H | display-authors=etal| title=Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. | journal=World J Gastroenterol | year= 2019 | volume= 25 | issue= 28 | pages= 3722-3737 | pmid=31391768 | doi=10.3748/wjg.v25.i28.3722 | pmc=6676555 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31391768 }} </ref> | |||
* '''Nutrition support''' | |||
Following a [[pancreatic]] surgery, patients are preferably kept nil per oral with liquid diet initiated on post-operative day 1 or 2 to a regular diet over the next 2 to 3 days, which increases the chances of enhanced recovery following a [[pancreatic]] surgery. Temporary [[total parenteral nutrition]] with correction of fluid and [[Electrolyte|electrolytes]] is reported to be associated with a shorter length of hospital stay. | |||
* '''[[Prophylactic]] [[somatostatin]] analogues''' | |||
[[Somatostatin]] or its analogues such as [[octreotide]] which mainly decrease the [[pancreatic]], [[gastric]] and [[enteric]] secretions can be used prophylactically after a [[pancreatic]] surgery to help reduce the risk of development of a [[pancreatic fistula]]. However, no significant benefit is observed with its use in patients with already established [[pancreatic fistula]]. | |||
* '''Intraabdominal [[Drain (surgery)|drain]] management''' | |||
A closed [[suction]] [[Drain (surgery)|drain]] is placed at the time of [[pancreatic]] surgery which is managed according to the characteristics of the drainage such as the volume output, color and content. If leakage is not evident, the drain is usually removed. On the other hand, high drain output rich in [[amylase]] is predictive of [[pancreatic fistula]] development, hence requiring a long term drainage. Most of the [[pancreatic fistula]] resolve spontaneously over a period of 4 to 6 weeks, however if the leak is persistent, the drain is left in place for a longer period and is removed in [[outpatient]] setting once the leakage has stopped.<ref name="pmid16172293">{{cite journal| author=Kazanjian KK, Hines OJ, Eibl G, Reber HA| title=Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients. | journal=Arch Surg | year= 2005 | volume= 140 | issue= 9 | pages= 849-54; discussion 854-6 | pmid=16172293 | doi=10.1001/archsurg.140.9.849 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16172293 }} </ref> | |||
==References== | ==References== | ||
Latest revision as of 22:38, 7 April 2021
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Overview
Pancreatic fistula is a known complication following a pancreatic surgery. Post operation management is focused towards prevention of complications arising as a consequence of pancreatic secretion from an anastomotic stump or the surface of skin which can subsequently complicate into intraabdominal abscess formation or life threatening hemorrhage. To reduce the risk of development of a post-operative pancreatic fistula, prophylactic measures such as nutrition support, prophylactic somatostatin analogues, drain management and a post-operation follow up is taken to reduce the risk of pancreatic fistula formation.
Primary prevention
Pancreatic fistula is a known complication following a pancreatic surgery. Post-operation management is focused towards prevention of complications arising as a consequence of pancreatic secretion from an anastomotic stump or the surface of skin which can subsequently complicate into intraabdominal abscess formation or life threatening hemorrhage. To reduce the risk of development of a post-operative pancreatic fistula, the following prophylactic measures are taken:[1]
- Nutrition support
Following a pancreatic surgery, patients are preferably kept nil per oral with liquid diet initiated on post-operative day 1 or 2 to a regular diet over the next 2 to 3 days, which increases the chances of enhanced recovery following a pancreatic surgery. Temporary total parenteral nutrition with correction of fluid and electrolytes is reported to be associated with a shorter length of hospital stay.
- Prophylactic somatostatin analogues
Somatostatin or its analogues such as octreotide which mainly decrease the pancreatic, gastric and enteric secretions can be used prophylactically after a pancreatic surgery to help reduce the risk of development of a pancreatic fistula. However, no significant benefit is observed with its use in patients with already established pancreatic fistula.
- Intraabdominal drain management
A closed suction drain is placed at the time of pancreatic surgery which is managed according to the characteristics of the drainage such as the volume output, color and content. If leakage is not evident, the drain is usually removed. On the other hand, high drain output rich in amylase is predictive of pancreatic fistula development, hence requiring a long term drainage. Most of the pancreatic fistula resolve spontaneously over a period of 4 to 6 weeks, however if the leak is persistent, the drain is left in place for a longer period and is removed in outpatient setting once the leakage has stopped.[2]
References
- ↑ Kawaida H, Kono H, Hosomura N, Amemiya H, Itakura J, Fujii H; et al. (2019). "Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery". World J Gastroenterol. 25 (28): 3722–3737. doi:10.3748/wjg.v25.i28.3722. PMC 6676555 Check
|pmc=value (help). PMID 31391768. - ↑ Kazanjian KK, Hines OJ, Eibl G, Reber HA (2005). "Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients". Arch Surg. 140 (9): 849–54, discussion 854-6. doi:10.1001/archsurg.140.9.849. PMID 16172293.