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HPB Surgery
Volume 2009 (2009), Article ID 404520, 8 pages
Clinical Study

Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

1Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
2IUSimon Cancer Center, 535 Barnhill Drive, Indianapolis, IN 46202, USA
3Departments of Surgery and Biochemistry and Molecular Biology, Cancer Research Institute, 980 W. Walnut Street R3-C522, Indianapolis, IN 46202, USA
4Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, IN 46202, USA

Received 24 May 2008; Revised 24 December 2008; Accepted 27 January 2009

Academic Editor: William Jarnagin

Copyright © 2009 C. Max Schmidt et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.