Asymptomatic low-output postoperative pancreatic fistula (POPF) often heal spontaneously within 21 days following surgery and are reported as cases of “biochemical leak.” However, some POPFs, especially those with high-output drainage
1frequently require more than 21 days to heal and are designated as grade B POPF. The reported frequency of grade B POPFs ranges from 16.4% to 22.1%.
- Seetharam P.
- Rodrigues G.S.
Postoperative pancreatic fistula: a surgeon's nightmare! an insight with a detailed literature review.
JOP. 2015; 16: 115-124
2In addition to prolonged drainage, a majority of cases require enteral/parenteral nutrition and/or somatostatin analogs to decrease output and accelerate closure. Complications associated with grade B POPF include increased hospital stay, costs, and patient discomfort. Grade B POPF is inevitable among certain patients following pancreatectomy; therefore, measures to accelerate closure and minimize clinical impact of this complication are required. The most frequently employed strategy for this purpose is the gradual withdrawal of the drainage tube (at 2 cm every several days) for clinically stable patients, while allowing for enteral feeding.
- Pulvirenti A.
- Marchegiani G.
- Pea A.
- Allegrini V.
- Esposito A.
- Casetti L.
- et al.
Clinical implications of the 2016 international study group on pancreatic surgery definition and grading of postoperative pancreatic fistula on 775 consecutive pancreatic resections.
Ann Surg. 2018; 268: 1069-1075
3However, this strategy induces discomfort and maintaining the drain in place is difficult; repeated traction of the drain apparatus from the sutured skin results in pain. Moreover, the final removal of the drain remains a prolonged process; the presumed rationale of gradual withdrawal is to permit closure from the inside out and prevent formation of residual abscesses following removal. However, recurrent POPFs or residual abscesses
- Veillette G.
- Dominguez I.
- Ferrone C.
- Thayer S.P.
- McGrath D.
- Warshaw A.L.
- et al.
Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience.
Arch Surg. 2008; 143: 476-481
4still occur in a few patients who underwent gradual withdrawal of drains. Thus, to accelerate closure of a well-developed, high-output POPF tract and avoid residual abscess, we developed a novel technique using transcatheter fistula tract occlusion (TCFTO). The present study reported TCFTO performed on 21 consecutive patients with asymptomatic grade B POPF.
- Tjaden C.
- Hinz U.
- Hassenpflug M.
- Fritz F.
- Fritz S.
- Grenacher L.
- et al.
Fluid collection after distal pancreatectomy: a frequent finding.
HPB. 2016; 18: 35-40
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- Postoperative pancreatic fistula: a surgeon's nightmare! an insight with a detailed literature review.JOP. 2015; 16: 115-124
- Clinical implications of the 2016 international study group on pancreatic surgery definition and grading of postoperative pancreatic fistula on 775 consecutive pancreatic resections.Ann Surg. 2018; 268: 1069-1075
- Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience.Arch Surg. 2008; 143: 476-481
- Fluid collection after distal pancreatectomy: a frequent finding.HPB. 2016; 18: 35-40
- Decoding grade B pancreatic fistula: a clinical and economical analysis and subclassification proposal.Ann Surg. 2019; 269: 1146-1153
Published online: January 20, 2023
Accepted: January 5, 2023
Received: November 1, 2022
Publication stageIn Press Uncorrected Proof
© 2023 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc.