Treatment Of Grade C Fistulas Following Pancreatoduodenectomy:A Case Series Report

BackgroundWith the development of medical technology, anesthesia and nutritional support continuous improvement, mortality after pancreaticoduodenectomy (PD) has decreased, however morbidity still remains high. Postoperative pancreatic fistula (POPF) is a main complication after pancreaticoduodenectomy can cause abdominal bleeding, gastrointestinal bleeding, abdominal abscesses and other serious secondary complication. Severe grade C pancreatic fistula even threaten the lives of patients. The purpose of this paper is to present a case series of postoperative grade C pancreatic fistula in a hepatopancreatobiliary surgery specialized center and the experience of management as well.MethodsBetween Mar 2013 and Mar 2016, a total of seven cases of postoperative grade C pancreatic fistula patients who underwent pancreaticoduodenectomy in the Department of Hepatopancreatobiliary, Second Affiliated Hospital school of Medicine, Zhejiang University were reviewed. Demographic, clinical manifestation, management of the series of seven postoperative grade C pancreatic fistulas patients were collected and analyzed respectively.ResultsAge of onset was 53-78, the median age was 67. Of the seven patients, six patients were male, and one patient was female. One patient was diagnosed as pancreatic cancer, two patients were diagnosed as duodenal cancer, three patients were diagnosed as lower part of common bile duct cancer, and one patient was diagnosed as pancreatic cancer combined hilar cholangiocarcinoma. Six patients underwent pancreaticoduodenectomy, and one patient underwent left hepatectomy+ pancreaticoduodenectomy. Seven patients in this group occurred pancreatic fistula of grade C. Surgery is the main treatment of POPF grade C. Surgical approach of four patients were drainage of the pancreatic duct, two patients chose the residual pancreatic resection, and the other one chose pancreatic sutured. Prognosis:five patients received successful treatment, two patients were dead due to serious illness.ConclusionGrade C pancreatic fistula after pancreaticoduodenectomy as severe complication, which needs timely diagnosis and effective surgery. Select a specific surgical approach has varied, each with advantages and disadvantages, which need based on the actual situation.