Postoperative pancreatic fistula: a review of traditional and emerging concepts

Abstract

Christopher B Nahm,1–3 Saxon J Connor,4 Jaswinder S Samra,1,2,5 Anubhav Mittal1,2,5 1Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, Australia; 2Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia; 3Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, Australia; 4Department of Surgery, Christchurch Hospital, Christchurch, New Zealand; 5Australian Pancreatic Centre, Sydney, Australia Abstract: Postoperative pancreatic fistula (POPF) remains the major cause of morbidity after pancreatic resection, affecting up to 41% of cases. With the recent development of a consensus definition of POPF, there has been a large number of reports examining various risk factors, prediction models, and mitigation strategies for this costly complication. Despite these strategies, the rates of POPF have not significantly diminished. Here, we review the literature and evidence regarding both traditional and emerging concepts in POPF prediction, prevention, and management. In particular, we review the evidence for the association between postoperative pancreatitis and POPF, and present a novel proposed mechanism for the development of POPF. Keywords: postoperative pancreatic fistula, postoperative pancreatitis, distal pancreatectomy, pancreaticoduodenectomy

Keywords

• Post-operative pancreatic fistula
• post-operative pancreatitis
• distal pancreatectomy
• pancreaticoduodenectomy