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| Postoperative negative-pressure drainage through a PEG tube can prevent pancreatic fistula after pancreatoduodenectomy |
| Aleksander Sowier a , Przemys?aw Pyda b , ∗, Sebastian Sowier a , Joanna Kapturzak a , Anna Rybak a , Jacek Bialecki a |
a Department of General, Minimally Invasive and Trauma Surgery, Franciszek Raszeja City Hospital in Poznan, ul. Mickiewicza 2, 60-834 Poznan, Poland
b Department of General and Endocrine Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355
Poznan, Poland
∗ Corresponding author.
E-mail addresses: przemo.pyda@gmail.com , sekretariat.chirurgia@raszeja.poznan.pl (P. Pyda). |
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Abstract Postoperative pancreatic fistula (POPF) is a well-known complication after pancreatoduodenectomy [1] . It is difficult to prevent due to a number of factors. The very placement and tightening of sutures in pancreatic tissue is challenging. Perfusion of the anastomosis edges is unpredictable. Another risk factor is the large amounts of fluids (comprising gastric and intestinal secretions, bile, and pancreatic juice) collected in the intestine near the pancreatic anastomosis, which increase the pressure in the first loop of the anastomosed intestine, and may ultimately rupture the pancreatoenteric anastomosis. Effective peristalsis, required to pass these fluids to subsequent sections of the intestine, takes time to return after such an extensive procedure. Increased pressure in the intestinal loop may also contribute to ischemia, by increasing the tension of the intestinal wall, constricting or even blocking its blood vessels. All these are aggravated by the chemical effects of intestinal contents. Any surgical errors may add the risk of POPF. The most significant risk factors include pancreatic duct size smaller than 3 mm; soft pancreatic parenchyma, ampullary, duodenal, cystic, or islet cell pathology; and massive intraoperative blood loss. Based on these factors a fistula risk score was devised to assess the probability of POPF formation after pancreatoduodenectomy [2] .
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2020, Vol. 19 
