Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2526
Peer-review started: February 26, 2019
First decision: June 19, 2019
Revised: July 10, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: September 6, 2019
Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess. This refractory complication can be fatal; therefore, intensive treatment is important. Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis, and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL. We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.
The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy, and pancreatic leakage was observed postoperatively. Intractable pancreatic fistula led to intraperitoneal abscess, and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8. The abscess resolved after 7 d of CLL. The second patient underwent distal pancreatectomy. Pancreatic leakage was observed, and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump. CLL was instituted from POD 9, and the abscess resolved after 4 d of CLL. The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma. Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula; however, intraperitoneal abscess was detected on POD 59. We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult. CLL was instituted from POD 63, and the abscess resolved after 1 wk of CLL.
CLL has therapeutic potential for postoperative pancreatic fistula.
Core tip: Pancreatic fistula after pancreatic surgery is a potentially fatal refractory complication. We describe the typical findings based on three patients who survived, and two patients who died of fatal complications. We also discuss the importance of intensive treatment for postoperative pancreatic fistula, with a literature review. Continuous local lavage (CLL) has been reevaluated as an effective treatment for severe infected pancreatitis, and our findings show that CLL shortened the therapeutic duration for postoperative pancreatic fistula. We suggest that CLL has therapeutic potential for postoperative pancreatic fistula. We also introduce our institutional protocol for CLL for postoperative pancreatic fistula.