Postoperative pancreatic fistula

• Verfasst von: Loos, Martin [VerfasserIn]
• Verfasst von: Strobel, Oliver [VerfasserIn]
• Verfasst von: Legominski, Matthias [VerfasserIn]
• Verfasst von: Dietrich, Maximilian [VerfasserIn]
• Verfasst von: Hinz, Ulf [VerfasserIn]
• Verfasst von: Brenner, Thorsten [VerfasserIn]
• Verfasst von: Heininger, Alexandra [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Verfasst von: Hackert, Thilo [VerfasserIn]
• Titel: Postoperative pancreatic fistula
• Titelzusatz: Microbial growth determines outcome
• Verf.angabe: Martin Loos, MC, Oliver Strobel, MD, Matthias Legominski, MD, Maximilian Dietrich, MD, Ulf Hinz, MSc, Thorsten Brenner, MD, Alexandra Heininger, MD, Markus A. Weigand, MD, Markus W. Büchler, MD, Thilo Hackert, MD
• E-Jahr: 2018
• Jahr: [December 2018]
• Umfang: 6 S.
• Fussnoten: Available online 11 September 2018 ; Gesehen am 08.07.2019
• Titel Quelle: Enthalten in: Surgery
• Ort Quelle: Amsterdam [u.a.] : Elsevier, 1995
• Jahr Quelle: 2018
• Band/Heft Quelle: 164(2018), 6, Seite 1185-1190
• ISSN Quelle: 1532-7361
• DOI: doi:10.1016/j.surg.2018.07.024
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1668721511

Abstract

Background - Postoperative pancreatic fistula is a dangerous complication in pancreatic surgery. This study assessed the impact of microbiologic pathogens detected in postoperative pancreatic fistula on clinical outcomes after partial pancreatoduodenectomy and distal pancreatectomy. - Methods - Microorganisms in postoperative pancreatic fistula were identified by microbiologic analyses from abdominal drains or intraoperative swabs during relaparotomy. Demographic, operative, and microbiologic data, as well as postoperative outcomes were examined. - Results - Of 2,752 patients undergoing partial pancreatoduodenectomy and distal pancreatectomy, 256 patients with clinically relevant postoperative pancreatic fistula (International Study Group of Pancreatic Surgery [ISGPS] grades B and C) were identified (9.3%) and microbiologic cultures were positive in 210 patients (82.0%), with a higher rate after partial pancreatoduodenectomy (95.8%) than after distal pancreatectomy (64.3%; P < .001). Microbiologic spectra differed distinctively between partial pancreatoduodenectomy and distal pancreatectomy. Detection of microorganisms in postoperative pancreatic fistula resulted in a higher morbidity and mortality, including postpancreatectomy hemorrhage (42.4% vs 21.7%; P=.009), sepsis (38.1% vs 6.5%; P < .001), wound infection (30.0% vs 6.5%; P=.001), reoperation (48.1% vs 10.9%; P < .001), hospital stay (median 42 vs 26 days; P < .001), and overall 90-day mortality (19.5% vs 4.3%; P=.013) and was identified as an independent risk factor for sepsis, wound infection, and reoperation in the multivariate analysis. - Conclusion - Detection of microorganisms in postoperative pancreatic fistula is frequent after pancreatic resection and indicates a turning point in the development of postoperative pancreatic fistula into a life-threatening condition. Whether early anti-infective therapy in combination with interventional measures or a surgical reintervention are warranted, has yet to be elucidated.