Background: Pancreatic fistula (PF) is still regarded as a serious complication both in terms of frequency and sequelae. The incidence varies greatly in different reports because of the different definitions used. The aim of this study was to compare several definitions of PF encountered in the current literature and to demonstrate that the PF rate in the same group of patients treated in a high volume center is dependent upon the definition applied. Methods: A Medline search of the last 10 years was performed as regards the definition of PF. A score was assigned to the reproducible definitions based upon two basic parameters: daily output (cm3) and duration of the fistula represented by the number of days between the postoperative day of onset and the duration of the complication. Four definitions were formulated and were then applied to a group of 242 patients that underwent pancreatic head or intermediate resections with pancreatico-jejunal anastomosis in our Pancreatic Unit between November 1996 and December 2000. Statistical analysis was carried out using the Yates correct χ2 test with statistical significance set at p < 0.05. Results: Among 26 different definitions identified, 14 were found suitable for the applied score. We formulated four final definitions summarizing the current concepts of PF. The incidence of PF ranged between 9.9 and 28.5% according to the different definitions applied with highly statistical differences between them. Conclusions: The PF rate after pancreatic resections is strictly dependent upon the definition used. An overall general agreement for an internationally accepted definition is urgently needed to correctly compare different experiences.

Keywords:
Pancreatic resection, Pancreatic fistula, Pancreatic fistula definition
1.
Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’Graggen K: Pancreatic fistula after pancreatic head resection. Br J Surg 2000;87:883–889.
2.
Sato N, Yamaguchi K, Chijiwa K, Tanaka M: Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 1998;133:1094–1098.
3.
Ishikawa O, Ohigashi H, Imaoka S, Teshima T, Inoue T, Sasaki Y, Iwanaga T, Nakaizumi A: Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreatoduodenectomy. Arch Surg 1991;126:885–889.
4.
Cogbill TH, Moore EE, Morris JA, Hoyt DB, Jurkovic GJ, Mucha P Jr, Ross SE, Feliciano DV, Shackford SR: Distal pancreatectomy for trauma: A multicenter experience. J Trauma 1991;31:1600–1606.
5.
Büchler M, Friess H, Klempa I, Hermanek P, Sulkowski U, Becker H, Schafmaier A, Baca I, Lorenz D, Meister R: Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg 1992;163:125–130.
6.
Ihse I, Larsson J, Lindstrom E: Surgical management of pure pancreatic fistulas. Hepato-Gastroenterology 1994;41:271–275.
7.
Pederzoli P, Bassi C, Falconi M, Camboni MG: Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Br J Surg 1994;81:265–269.
8.
Cullen JJ, Sarr MG, Ilstrup DM: Pancreatic anastomotic leak after pancreaticoduodenectomy: Incidence, significance and management. Am J Surg 1994;168:295–298.
9.
Fernandez-del Castillo C, Rattner DW, Warshaw AL: Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–299.
10.
Yeo CJ, Cameron JL, Maher MM, Sauter PK, Zahurak ML, Talamini MA, Lillemoe KD, Pitt HA: A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580–588.
11.
Nwariaku FE, Terracina A, Mileski WJ, Minei JP, Carrico CJ: Is octreotide beneficial following pancreatic injury? Am J Surg 1995;170:582–585.
12.
Parviainen MC, Sand JA, Nordback IH: Coincidence of pancreatic and biliary leakages after pancreaticoduodenal resections. Hepatogastroenterology 1996;43:1246–1249.
13.
Ridgeway MG, Stabile BE: Surgical management and treatment of pancreatic fistulas. Surg Clin North Am 1996;76:1159–1173.
14.
Andivot T, Cardoso J, Dousset B, Soubrane O, Bonnichon P, Chapuis Y: Complications of two types of pancreatic anastomosis after pancreaticoduodenectomy. Ann Chir 1996;50:431–437.
15.
Howard JM: Pancreatojejunostomy: Leakage is a preventable complication of the Whipple resection. J Am Coll Surg 1997;184:454–457.
16.
Lowy AM, Lee JE, Pisters PW, Davidson VS, Fenoglio CJ, Standford P, Jinnah R, Evans DB: Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease. Ann Surg 1997;226:632–641.
17.
Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon VF Jr, Malangoni MA: Pancreatic trauma: A ten-year multi-institutional experience. Am Surg 1997;63:598–604.
18.
Chew DKW, Attiyeh FF: Experience with the Whipple procedure (pancreaticoduodenectomy) in a University-affiliated community hospital. Am J Surg 1997;174:312–315.
19.
Howard TJ, Stonerock CE, Sarkar J, Lehman GA, Sherman S, Wiebke EA, Madura JA, Broadie TA: Contemporary treatment strategies for external pancreatic fistulas. Surgery 1998;124:627–632.
20.
Sato N, Yamaguchi K, Chijiiwa K, Tanaka M: Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg 1998;133:1094–1098.
21.
Cunningham JD, Weyant MT, Levitt M, Brower ST, Aufses AH Jr: Complications requiring reoperation following pancreatectomy. Int J Pancreatol 1998;24:23–29.
22.
Young PR Jr, Meredith JW, Baker CC, Thomason MH, Chang MC: Pancreatic injuries resulting from penetrating trauma: A multi-institution review. Am Surg 1998;64:838–843.
23.
Park BJ, Alexander HR, Libutti SK, Huang J, Royalty D, Skaruis MC, Jensen RT, Gorden P, Doppman JL, Shawker TH, Fraker DL, Norton JA, Bartolett DL: Operative management of islet-cell tumors arising in the head of the pancreas. Surgery 1998;124:1056–1061.
24.
Heslin MJ, Harrison LE, Brooks AD, Hochwald SN, Coit DG, Brennan MF: Is intra-abdominal drainage necessary after pancreaticoduodenectomy? J Gastrointest Surg 1998;2:373–378.
25.
Suzuky Y, Fujino Y, Tanioka Y: Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 1999;86:608–611.
26.
Slim K, Buc E, Lescure G, Chanudet G, Pezet D, Chipponi J: Use of lanreotide in the prevention of pancreatic fistula after cephalic duodeno-pancreatectomy. Preliminary study. Chirurgie 1999;124:661–665.
27.
Takano S, Ito Y, Watanabe Y, Yokoyama T, Kubota N, Iwai S: Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Br J Surg 2000;87:423–427.
28.
Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P: Management of complications after pancreaticoduodenenctomy in a high volume centre: results on 150 consecutive patients. Dig Surg 2001;18:453–458.
29.
Berdah S, Panis Y, Gleizes V, Sastre B, Valleur P: Reappraisal of pancreaticojejunostomy after pancreaticoduodenenctomy: A report of 86 cases with particular reference to the rate of pancreatic fistulation. Eur J Surg 1997;163:365–369.
30.
Bassi C, Butturini G, Falconi M Salvia R, Sartori N, Caldiron E, Talamini G, Pederzoli P: Prospective randomised pilot study of management of the pancreatic stump following distal resection. HPB 1999;1:203–207.
31.
Brennan MF, Moccia RD, Klimstra D: Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 1996;223:506–512.
32.
Fabre JM, Houry S, Manderscheid JC, Huguier M, Baumel H: Surgery for left-sided pancreatic cancer. Br J Surg 1996;83:1065–1070.
33.
Li-Ling J, Irving M: Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas: A systematic review of randomized controlled trials. Br J Surg 2001;88:190–199.
34.
Bruce J, Krukowski ZH, Al-Khairy, Russell EM and Park KGM: Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001;88:1157–1168.
35.
Shinchi H, Traverso LW: What is a significant leak after pancreaticoduodenectomy? Pancreas Club, Inc. Abstract Book 2003, 34.
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2004
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