An ongoing dispute in the management of severe pancreatic fistula: Pancreatospleenectomy or not?

Table 1 Classification of pancreatic fistula (from Bassi et al[1])

	Grade A	Grade B	Grade C
Clinical conditions	Well	Often well	Ill, appearing bad
Specific treatment1	No	Yes/no	Yes
US/CT	Negative	Negative/positive	Positive
Persistent drainage after 3 wk2	No	No	Yes
Re-operation	No	No	Yes
Death related to PF	No	No	Possibly yes
Sings of infection	No	Yes	Yes
Sepsis	No	No	Yes
Readmission	No	Yes/no	Yes/no

¹Partial or total parenteral nutrition, antibiotics, enteral nutrition, somatostatin analogue, and/or minimal invasive drainage;

²With or without a drain in situ. PF: Pancreatic fistula; US: Ultrasonography; CT: Computed tomography scan.

Table 2 Incidence and management of pancreatic fistula in different studies n (%)

Authors	n	Incidence of PF/grade C PF	Treatment		Mortality rate
			Conservative or surgical drainage	CP	Conservative	CP
Cullen et al[5], 1994	375	66 (18)/18 (4.8)	11 (61)	7 (39)	5 (8)
Farley et al[6], 1996	458	NA	NA	17	NA	4 (24)
van Berge Henegouwen et al[7], 1997	269	29 (11)/NA	21	8	8 (38)	0
Fuks et al[8], 2009	680	111 (16.3)/36 (5.2)	34 (95)	2 (5)	14 (38.8)
de Castro et al[9], 2005	459	41 (8.9)/27 (10.2)	18 (67)	9 (33)	6 (15)	0
Büchler et al[10], 2003	617	20 (3.2)/NA	NA	0	0	0
Haddad et al[11], 2009	117	35 (30)/14 (12)	9 (65)	5 (35)	2 (22)	3 (60)

PF: Pancreatic fistul; CP: Completion pancreatectomy; NA: Not available.