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International Journal of Surgical Oncology
Volume 2012, Article ID 602478, 10 pages
http://dx.doi.org/10.1155/2012/602478
Review Article

Pancreatic Fistula after Pancreatectomy: Definitions, Risk Factors, Preventive Measures, and Management—Review

Department of Surgery, Sultan Qaboos University Hospital, 123 Muscat, Oman

Received 1 December 2011; Accepted 24 January 2012

Academic Editor: Timothy M. Pawlik

Copyright © 2012 Norman Oneil Machado. 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.

Linked References

  1. C. M. Schmidt, E. S. Powell, C. T. Yiannoutsos et al., “Pancreaticoduodenectomy: a 20-year experience in 516 patients,” Archives of Surgery, vol. 139, no. 7, pp. 718–727, 2004. View at Publisher · View at Google Scholar · View at Scopus
  2. C. Bassi, M. Falconi, R. Salvia, G. Mascetta, E. Molinari, and P. P. Pederzoli, “Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients,” Digestive Surgery, vol. 18, no. 6, pp. 453–457, 2001. View at Publisher · View at Google Scholar · View at Scopus
  3. M. P. Callery, W. B. Pratt, and C. M. Vollmer, “Prevention and management of pancreatic fistula,” Journal of Gastrointestinal Surgery, vol. 13, no. 1, pp. 163–173, 2009. View at Publisher · View at Google Scholar · View at Scopus
  4. Y. M. Yang, X. D. Tian, Y. Zhuang, W. M. Wang, Y. L. Wan, and Y. T. Huang, “Risk factors of pancreatic leakage after pancreaticoduodenectomy,” World Journal of Gastroenterology, vol. 11, no. 16, pp. 2456–2461, 2005. View at Google Scholar · View at Scopus
  5. S. V. Shrikhande and M. A. D'Souza, “Pancreatic fistula after pancreatectomy: evolving definitions, preventive strategies and modern management,” World Journal of Gastroenterology, vol. 14, no. 38, pp. 5789–5796, 2008. View at Publisher · View at Google Scholar · View at Scopus
  6. E. C. H. Lai, S. H. Y. Lau, and W. Y. Lau, “Measures to prevent pancreatic fistula after pancreatoduodenectomy: a comprehensive review,” Archives of Surgery, vol. 144, no. 11, pp. 1074–1080, 2009. View at Publisher · View at Google Scholar · View at Scopus
  7. J. L. Cameron, T. S. Riall, J. Coleman, and K. A. Belcher, “One thousand consecutive pancreaticoduodenectomies,” Annals of Surgery, vol. 244, no. 1, pp. 10–15, 2006. View at Publisher · View at Google Scholar · View at Scopus
  8. C. Bassi, C. Dervenis, G. Butturini et al., “International study group on pancreatic fistula definition. Post-operative pancreatic fistula: an international study group (ISGPF) definition,” Surgery, vol. 138, no. 1, pp. 8–13, 2005. View at Google Scholar
  9. N. Pecorelli, G. Balzano, G. Capretti, A. Zerbi, V. Di Carlo, and M. Braga, “Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital,” Journal of Gastrointestinal Surgery, vol. 16, no. 3, pp. 518–523, 2011. View at Publisher · View at Google Scholar
  10. C. Bassi, G. Butturini, E. Molinari et al., “Pancreatic fistula rate after pancreatic resection: the importance of definitions,” Digestive Surgery, vol. 21, no. 1, pp. 54–59, 2004. View at Publisher · View at Google Scholar
  11. A. M. Lowy, J. E. Lee, P. W. T. Pisters et al., “Prospective, randomized trial of octreotide to prevent pancreatic fistula after pancreaticoduodenectomy for malignant disease,” Annals of Surgery, vol. 226, no. 5, pp. 632–641, 1997. View at Publisher · View at Google Scholar · View at Scopus
  12. S. M. Strasberg, D. C. Linehan, P. A. Clavien, and J. S. Barkun, “Proposal for definition and severity grading of pancreatic anastomosis failure and pancreatic occlusion failure,” Surgery, vol. 141, no. 4, pp. 420–426, 2007. View at Publisher · View at Google Scholar · View at Scopus
  13. J. W. Lin, J. L. Cameron, C. J. Yeo, T. S. Riall, and K. D. Lillemoe, “Risk factors and outcome in post pancreaticoduodenectomy pancreaticocutaneous fistula,” Journal of Gastrointestinal Surgery, vol. 8, pp. 951–959, 2004. View at Google Scholar
  14. M. I. Van Berge Henegouwen, L. T. De Wit, T. M. Van Gulik, H. Obertop, and D. J. Gouma, “Incidence, risk factors, and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant,” Journal of the American College of Surgeons, vol. 185, no. 1, pp. 18–24, 1997. View at Google Scholar · View at Scopus
  15. C. J. Yeo, J. L. Cameron, K. D. Lillemoe et al., “Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial,” Annals of Surgery, vol. 232, no. 3, pp. 419–429, 2000. View at Publisher · View at Google Scholar · View at Scopus
  16. S. Matsusue, H. Takeda, Y. Nakamura, S. Nishimura, and S. Koizumi, “A prospective analysis of the factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies,” Surgery Today, vol. 28, no. 7, pp. 719–726, 1998. View at Publisher · View at Google Scholar · View at Scopus
  17. R. T. P. Poon, S. H. Lo, D. Fong, S. T. Fan, and J. Wong, “Prevention of pancreatic anastomotic leakage after pancreaticoduodenectomy,” American Journal of Surgery, vol. 183, no. 1, pp. 42–52, 2002. View at Publisher · View at Google Scholar · View at Scopus
  18. T. S. Yeh, Y. Y. Jan, L. B. Jeng et al., “Pancreaticojejunal anastomotic leak after pancreaticoduodenectomy—multivariate analysis of perioperative risk factors,” Journal of Surgical Research, vol. 67, no. 2, pp. 119–125, 1997. View at Publisher · View at Google Scholar · View at Scopus
  19. O. Ishikawa, H. Ohigashi, S. Imaoka et al., “Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreatoduodenectomy,” Archives of Surgery, vol. 126, no. 7, pp. 885–889, 1991. View at Google Scholar · View at Scopus
  20. J. Hoffman, “Does prior adjuvant chemoradiotherapy lead to a safer pancreatoduodenectomy?” Annals of Surgical Oncology, vol. 13, no. 1, pp. 7–9, 2006. View at Publisher · View at Google Scholar
  21. W. B. Pratt, M. P. Callery, and C. M. Vollmer, “Risk prediction for development of pancreatic fistula using the ISGPF classification scheme,” World Journal of Surgery, vol. 32, no. 3, pp. 419–428, 2008. View at Publisher · View at Google Scholar · View at Scopus
  22. J. F. Sledzianowski, J. P. Duffas, F. Muscari, B. Suc, and F. Fourtanier, “Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy,” Surgery, vol. 137, no. 2, pp. 180–185, 2005. View at Publisher · View at Google Scholar · View at Scopus
  23. V. Pannegeon, P. Pessaux, A. Sauvanet, M. P. Vullierme, R. Kianmanesh, and J. Belghiti, “Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment,” Archives of Surgery, vol. 141, no. 11, pp. 1071–1076, 2006. View at Publisher · View at Google Scholar · View at Scopus
  24. M. P. Ridolfini, S. Alfieri, S. Gourgiotis et al., “Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?” World Journal of Gastroenterology, vol. 13, no. 38, pp. 5096–5100, 2007. View at Google Scholar · View at Scopus
  25. A. Sauvanet, C. Partensky, B. Sastre et al., “Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club,” Surgery, vol. 132, no. 5, pp. 836–843, 2002. View at Publisher · View at Google Scholar · View at Scopus
  26. K. D. Lillemoe, S. Kaushal, J. L. Cameron, T. A. Sohn, H. A. Pitt, and C. J. Yeo, “Distal pancreatectomy: indications and outcomes in 235 patients,” Annals of Surgery, vol. 229, no. 5, pp. 693–700, 1999. View at Publisher · View at Google Scholar · View at Scopus
  27. W. Pratt, S. K. Maithel, T. Vanounou, M. P. Callery, and C. M. Vollmer, “Postoperative pancreatic fistulas are not equivalent after proximal, distal, and central pancreatectomy,” Journal of Gastrointestinal Surgery, vol. 10, no. 9, pp. 1264–1279, 2006. View at Publisher · View at Google Scholar · View at Scopus
  28. B. K. P. Goh, Y. M. Tan, Y. F. A. Chung et al., “Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution,” Archives of Surgery, vol. 143, no. 10, pp. 956–965, 2008. View at Publisher · View at Google Scholar · View at Scopus
  29. P. Reissman, Y. Perry, A. Cuenca et al., “Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma,” American Journal of Surgery, vol. 169, no. 6, pp. 585–588, 1995. View at Publisher · View at Google Scholar · View at Scopus
  30. K. Tran, C. Van Eijck, V. Di Carlo et al., “Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial,” Annals of Surgery, vol. 236, no. 4, pp. 422–428, 2002. View at Publisher · View at Google Scholar · View at Scopus
  31. J. M. Waugh and O. T. Clagett, “Resection of the duodenum and head of the pancreas for carcinoma. An analysis of thirty cases,” Surgery, vol. 20, no. 2, pp. 224–232, 1946. View at Google Scholar · View at Scopus
  32. C. J. Yeo, J. L. Cameron, M. M. Maher et al., “A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy,” Annals of Surgery, vol. 222, no. 4, pp. 580–592, 1995. View at Google Scholar · View at Scopus
  33. A. Sauvanet, J. Belghiti, Y. Panis et al., “Pancreaticogastrostomy after pancreatoduodenectomy,” HPB Surgery, vol. 6, no. 2, pp. 91–98, 1992. View at Google Scholar · View at Scopus
  34. S. Takano, Y. Ito, Y. Watanabe, T. Yokoyama, N. Kubota, and S. Iwai, “Pancreaticojejunostomy versus pancreaticogastrostomy in reconstructions following pancreaticoduodenectomy,” British Journal of Surgery, vol. 87, no. 4, pp. 423–427, 2000. View at Publisher · View at Google Scholar · View at Scopus
  35. G. V. Aranha, P. Hodul, E. Golts, D. Oh, J. Pickleman, and S. Creech, “A comparison of pancreaticogastrostomy and pancreaticojejunostomy following pancreaticoduodenectomy,” Journal of Gastrointestinal Surgery, vol. 7, no. 5, pp. 672–682, 2003. View at Publisher · View at Google Scholar · View at Scopus
  36. J. P. Duffas, B. Suc, S. Msika, G. Fountanier, F. Muscari, and J. M. Hay, “French Association for Research in Surgery. A controlled randomized multicenter trial of pancreaticogastrostomy or pancreaticojejunostomy after pancreaticoduodenectomy,” The American Journal of Surgery, vol. 189, no. 6, pp. 720–729, 2005. View at Google Scholar
  37. C. Bassi, M. Falconi, E. Molinari et al., “Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study,” Annals of Surgery, vol. 242, no. 6, pp. 767–773, 2005. View at Publisher · View at Google Scholar · View at Scopus
  38. A. McKay, S. Mackenzie, F. R. Sutherland et al., “Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy,” British Journal of Surgery, vol. 93, no. 8, pp. 929–936, 2006. View at Publisher · View at Google Scholar · View at Scopus
  39. M. N. Wente, S. V. Shrikhande, M. W. Müller et al., “Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis,” American Journal of Surgery, vol. 193, no. 2, pp. 171–183, 2007. View at Publisher · View at Google Scholar
  40. S. M. Strasberg, J. A. Drebin, and N. J. Soper, “Evolution and current status of the whipple procedure: an update for gastroenterologists,” Gastroenterology, vol. 113, no. 3, pp. 983–994, 1997. View at Publisher · View at Google Scholar · View at Scopus
  41. A. Stojadinovic, A. Brooks, A. Hoos, D. P. Jaques, K. C. Conlon, and M. F. Brennan, “An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma,” Journal of the American College of Surgeons, vol. 196, no. 6, pp. 954–964, 2003. View at Publisher · View at Google Scholar · View at Scopus
  42. S. G. Marcus, H. Cohen, J. H. C. Ranson et al., “Optimal management of the pancreatic remnant after pancreaticoduodenectomy,” Annals of Surgery, vol. 221, no. 6, pp. 635–648, 1995. View at Google Scholar · View at Scopus
  43. Y. Suzuki, Y. Fujino, Y. Tanioka et al., “Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size,” Archives of Surgery, vol. 137, no. 9, pp. 1044–1048, 2002. View at Google Scholar · View at Scopus
  44. C. Bassi, M. Falconi, E. Molinari et al., “Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial,” Surgery, vol. 134, no. 5, pp. 766–771, 2003. View at Publisher · View at Google Scholar · View at Scopus
  45. A. W. Khan, A. K. Agarwal, and B. R. Davidson, “Isolated Roux loop duct-to-mucosa pancreaticojejunostomy avoids pancreatic leaks in pancreaticoduodenectomy,” Digestive Surgery, vol. 19, no. 3, pp. 199–204, 2002. View at Publisher · View at Google Scholar · View at Scopus
  46. C. D. Sutton, G. Garcea, S. A. White et al., “Isolated roux-loop pancreaticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks,” Journal of Gastrointestinal Surgery, vol. 8, no. 6, pp. 701–705, 2004. View at Publisher · View at Google Scholar
  47. L. Kaman, S. Sanyal, A. Behera, R. Singh, and R. N. Katariya, “Isolated roux loop pancreaticojejunostomy vs single loop pancreaticojejunostomy after pancreaticoduodenectomy,” International Journal of Surgery, vol. 6, no. 4, pp. 306–310, 2008. View at Publisher · View at Google Scholar · View at Scopus
  48. K. Wada and L. W. Traverso, “Pancreatic anastomotic leak after the Whipple procedure is reduced using the surgical microscope,” Surgery, vol. 139, no. 6, pp. 735–742, 2006. View at Publisher · View at Google Scholar · View at Scopus
  49. S. M. Strasberg, J. A. Drebin, N. A. Mokadam et al., “Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure,” Journal of the American College of Surgeons, vol. 194, no. 6, pp. 746–760, 2002. View at Publisher · View at Google Scholar · View at Scopus
  50. M. G. Sarr, K. E. Behrns, and J. A. Van Heerden, “Total pancreatectomy: an objective analysis of its use in pancreatic cancer,” Hepato-Gastroenterology, vol. 40, no. 5, pp. 418–421, 1993. View at Google Scholar · View at Scopus
  51. H. M. Karpoff, D. S. Klimstra, M. F. Brennan, and K. C. Conlon, “Results of total pancreatectomy for adenocarcinoma of the pancreas,” Archives of Surgery, vol. 136, no. 1, pp. 44–48, 2001. View at Google Scholar · View at Scopus
  52. F. Yoshimi, H. Ono, Y. Asato et al., “Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy in patients undergoing pancreatoduodenectomy to promote earlier discharge from hospital,” Surgery Today, vol. 26, no. 8, pp. 665–667, 1996. View at Google Scholar · View at Scopus
  53. J. D. Roder, H. J. Stein, K. A. Bottcher, R. Busch, C. D. Heidecke, and J. R. Siewert, “Stented versus non stented pancreaticojejunostomy after pancreaticoduodenectomy: a prospective study,” Annals of Surgery, vol. 229, no. 1, pp. 41–48, 1999. View at Google Scholar
  54. T. Imaizumi, T. Hatori, K. Tobita, A. Fukuda, K. Takasaki, and H. Makuuchi, “Pancreaticojejunostomy using duct-to-mucosa anastomosis without a stenting tube,” Journal of Hepato-Biliary-Pancreatic Surgery, vol. 13, no. 3, pp. 194–201, 2006. View at Publisher · View at Google Scholar · View at Scopus
  55. J. M. Winter, J. L. Cameron, K. A. Campbell et al., “Does pancreatic suct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial,” Journal of Gastrointestinal Surgery, vol. 10, no. 9, pp. 1280–1290, 2006. View at Publisher · View at Google Scholar · View at Scopus
  56. S. Ohwada, Y. Tanahashi, T. Ogawa et al., “In situ vs ex situ pancreatic duct stents of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy with billroth I-type reconstruction,” Archives of Surgery, vol. 137, no. 11, pp. 1289–1293, 2002. View at Google Scholar · View at Scopus
  57. R. T. P. Poon, S. T. Fan, C. M. Lo et al., “EXternal drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial,” Annals of Surgery, vol. 246, no. 3, pp. 425–433, 2007. View at Publisher · View at Google Scholar · View at Scopus
  58. P. Pessaux, A. Sauvanet, C. Mariette et al., “External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial,” Annals of Surgery, vol. 253, no. 5, pp. 879–885, 2011. View at Publisher · View at Google Scholar
  59. M. Buchler, H. Friess, I. Klempa et al., “Role of octreotide in the prevention of postoperative complications following pancreatic resection,” American Journal of Surgery, vol. 163, no. 1, pp. 125–131, 1992. View at Publisher · View at Google Scholar
  60. P. Pederzoli, C. Bassi, M. Falconi, and M. G. Camboni, “Efficacy of octreotide in the prevention of complications of elective pancreatic surgery,” British Journal of Surgery, vol. 81, no. 2, pp. 265–269, 1994. View at Google Scholar
  61. M. Montorsi, M. Zago, F. Mosca et al., “Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial,” Surgery, vol. 117, no. 1, pp. 26–31, 1995. View at Publisher · View at Google Scholar · View at Scopus
  62. H. Friess, H. G. Beger, U. Sulkowski et al., “Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis,” British Journal of Surgery, vol. 82, no. 9, pp. 1270–1273, 1995. View at Publisher · View at Google Scholar · View at Scopus
  63. C. Gouillat, J. Chipponi, J. Baulieux, C. Partensky, J. Saric, and B. Gayet, “Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy,” British Journal of Surgery, vol. 88, no. 11, pp. 1456–1462, 2001. View at Publisher · View at Google Scholar · View at Scopus
  64. M. G. L. Sarr and E. A. Woltering, “The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial,” Journal of the American College of Surgeons, vol. 196, no. 4, pp. 556–565, 2003. View at Publisher · View at Google Scholar
  65. Y. S. Shan, E. D. Sy, and P. W. Lin, “Role of somatostatin in the prevention of pancreatic stump-related morbidity following elective pancreaticoduodenectomy in high-risk patients and elimination of surgeon-related factors: prospective, randomized, controlled trial,” World Journal of Surgery, vol. 27, no. 6, pp. 709–714, 2003. View at Publisher · View at Google Scholar · View at Scopus
  66. B. Suc, S. Msika, M. Piccinini et al., “Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial,” Archives of Surgery, vol. 139, no. 3, pp. 288–294, 2004. View at Publisher · View at Google Scholar
  67. U. J. Hesse, C. DeDecker, P. Houtmeyers et al., “Prospectively randomized trial using perioperative low-dose octreotide to prevent organ-related and general complications after pancreatic surgery and pancreatico-jejunostomy,” World Journal of Surgery, vol. 29, no. 10, pp. 1325–1328, 2005. View at Publisher · View at Google Scholar · View at Scopus
  68. S. Connor, N. Alexakis, O. J. Garden, E. Leandros, J. Bramis, and S. J. Wigmore, “Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery,” British Journal of Surgery, vol. 92, no. 9, pp. 1059–1067, 2005. View at Publisher · View at Google Scholar · View at Scopus
  69. A. A. Alghamdi, A. M. Jawas, and R. S. Hart, “Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis,” Canadian Journal of Surgery, vol. 50, no. 6, pp. 459–466, 2007. View at Google Scholar · View at Scopus
  70. K. K. Kazanjian, O. J. Hines, G. Eibl et al., “Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients,” Archives of Surgery, vol. 140, no. 9, pp. 849–855, 2005. View at Publisher · View at Google Scholar · View at Scopus
  71. N. Munoz-Bongrand, A. Sauvanet, A. Denys, A. Sibert, V. Vilgrain, and J. Belghiti, “Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy,” Journal of the American College of Surgeons, vol. 199, no. 2, pp. 198–203, 2004. View at Publisher · View at Google Scholar · View at Scopus
  72. C. M. Halloran, P. Ghaneh, L. Bosonnet, M. N. Hartley, R. Sutton, and J. P. Neoptolemos, “Complications of pancreatic cancer resection,” Digestive Surgery, vol. 19, no. 2, pp. 138–146, 2002. View at Publisher · View at Google Scholar · View at Scopus
  73. E. F. Yekebas, L. Wolfram, G. Cataldegirmen et al., “Postpancreatectomy hemorrhage: diagnosis and treatment—an analysis in 1669 consecutive pancreatic resections,” Annals of Surgery, vol. 246, no. 2, pp. 269–280, 2007. View at Publisher · View at Google Scholar · View at Scopus
  74. S. M. De Castro, K. F. Kuhlman, O. R. Busch, O. M. van Delden, J. S. Lameris, and T. M. van Gulik, “Delayed massive haemorrhage after of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant,” Journal of the American College of Surgeons, vol. 185, no. 1, pp. 18–24, 1997. View at Google Scholar
  75. P. Bachellier, E. Oussoultzoglou, E. Rosso et al., “Pancreatico gastrostomy as a salvage procedure to treat severe postoperative pancreatic fistula after pancreaticoduodenectomy,” Archives of Surgery, vol. 143, no. 10, pp. 966–970, 2008. View at Google Scholar
  76. C. D. Smith, M. G. Sarr, J. A. VanHeerden, and M. Trede, “Completion pancreatectomy following pancreaticoduodenectomy: clinical experience,” World Journal of Surgery, vol. 16, no. 3, pp. 521–524, 1992. View at Publisher · View at Google Scholar · View at Scopus