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Claudio Bassi - One of the best experts on this subject based on the ideXlab platform.
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modifications in the international study group for Pancreatic surgery isgps definition of postoperative Pancreatic Fistula
Translational Gastroenterology and Hepatology, 2017Co-Authors: Alessandra Pulvirenti, Marco Ramera, Claudio BassiAbstract:Postoperative Pancreatic Fistula (POPF) remains the major postoperative cause of morbidity and mortality following Pancreatic surgery. Since 2005, the International Study Group of Pancreatic Fistula (ISGPF) definition and classification has been adopted worldwide allowing the comparison among different surgical approaches and mitigation strategies. Over the last 11 years, several limitations have emerged from clinical practice and in 2016 the International Study Group for Pancreatic Surgery (ISGPS) updated the POPF definition and grading system. Objectives of this review article were to summarize modifications in the updated ISGPS definition and to illustrate their clinical impact.
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the 2016 update of the international study group isgps definition and grading of postoperative Pancreatic Fistula 11 years after
Surgery, 2017Co-Authors: Claudio Bassi, Peter J Allen, Giovanni Marchegiani, Christos Dervenis, M G Sarr, Mohammad Abu Hilal, Mustapha Adham, Roland Andersson, Horacio J Asbun, Marc G BesselinkAbstract:Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative Pancreatic Fistula that has been accepted universally. Eleven years later, because postoperative Pancreatic Fistula remains one of the most relevant and harmful complications of Pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative Pancreatic Fistula in clinical practice. The aim of the present report is to verify the value of the International Study Group of Pancreatic Fistula definition and grading of postoperative Pancreatic Fistula and to update the International Study Group of Pancreatic Fistula classification in light of recent evidence that has emerged, as well as to address the lingering controversies about the original definition and grading of postoperative Pancreatic Fistula. Methods The International Study Group of Pancreatic Fistula reconvened as the International Study Group in Pancreatic Surgery in order to perform a review of the recent literature and consequently to update and revise the grading system of postoperative Pancreatic Fistula. Results Based on the literature since 2005 investigating the validity and clinical use of the original International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative Pancreatic Fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative Pancreatic Fistula. Consequently, the former “grade A postoperative Pancreatic Fistula” is now redefined and called a “biochemical leak,” because it has no clinical importance and is no longer referred to a true Pancreatic Fistula. Postoperative Pancreatic Fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative Pancreatic Fistula refers to those postoperative Pancreatic Fistula that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the Pancreatic Fistula. Conclusion This new definition and grading system of postoperative Pancreatic Fistula should lead to a more universally consistent evaluation of operative outcomes after Pancreatic operation and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a Pancreatic Fistula. Use of this updated classification will also allow for more precise comparisons of surgical quality between surgeons and units who perform Pancreatic surgery.
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Pancreaticojejunostomy after Pancreaticoduodenectomy: Suture material and incidence of post-operative Pancreatic Fistula.
Pancreatology, 2015Co-Authors: Stefano Andrianello, Giovanni Butturini, Alessandra Pulvirenti, Valentina Allegrini, Giovanni Marchegiani, Giuseppe Malleo, Roberto Salvia, Claudio BassiAbstract:Abstract Purpose Pancreatic Fistula represents the most important complication in terms of clinical management and costs after Pancreaticoduodenectomy. A lot of studies have investigated several techniques in order to reduce Pancreatic Fistula, but data on the effect of sutures material on Pancreatic Fistula are not available. The analysis investigated the role of suture material in influencing Pancreatic Fistula rate and severity. Methods Results from 130 consecutive Pancreaticoduodenectomy with Pancreaticojejunostomy performed between March 2013 and September 2014 were prospectively collected and analyzed. In 65 cases Pancreaticojejunostomy was performed with absorbable sutures, in the other 65 cases using non-absorbable sutures (polyester, silk and polybutester). Results Pancreaticojejunostomy with non-absorbable sutures had the same incidence of Pancreatic Fistula, but less severe and with less episodes of post-operative bleeding if compared with absorbable sutures. A sub-analysis was carried out comparing polydioxanone with polyester: the latter was associated with a lower Pancreatic Fistula rate (11.9% vs. 31.7%; p = 0,01) and less severe Pancreatic anastomosis dehiscence (grade C - 0% vs. 30%; p = 0.05). Univariate and multivariate analysis confirmed that hard Pancreatic texture, Pancreatic ductal adenocarcinoma at final histology and the use of polyester for Pancreaticojejunostomy were associated with a lower Pancreatic Fistula rate (p Conclusion Further studies are needed to investigate the effects of Pancreatic juice and bile on different sutures and Pancreatic tissue response to different materials. However, Pancreaticojejunostomy performed with polyester sutures is safe and feasible and is associated to a lower incidence of Pancreatic Fistula with less severe clinical impact.
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diagnosis and management of postoperative Pancreatic Fistula
Langenbeck's Archives of Surgery, 2014Co-Authors: Giuseppe Malleo, Giovanni Butturini, Alessandra Pulvirenti, Giovanni Marchegiani, Roberto Salvia, Claudio BassiAbstract:Background Postoperative Pancreatic Fistula (POPF) is the leading complication after partial Pancreatic resection and is associated with increased length of hospital stay and resource utilization. The introduction of a common definition in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), which has been since employed in the vast majority of reports, has allowed a reliable comparison of surgical results. Despite the systematic investigation of risk factors and of surgical techniques, the incidence of POPF did not change in recent years, whereas the associated mortality has decreased.
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a grading system can predict clinical and economic outcomes of Pancreatic Fistula after Pancreaticoduodenectomy results in 755 consecutive patients
Langenbeck's Archives of Surgery, 2011Co-Authors: Despoina Daskalaki, Giovanni Butturini, Enrico Molinari, Paolo Pederzoli, Stefano Crippa, Claudio BassiAbstract:Aim Postoperative Pancreatic Fistula (POPF) has a wide range of clinical and economical implications due to the difference of the associated complications and management. The aim of this study is to verify the applicability of the International Study Group of Pancreatic Fistula (ISGPF) definition and its capability to predict hospital costs.
Markus W Buchler - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Pancreatic Fistula: Microbial growth determines outcome.
Surgery, 2018Co-Authors: Martin Loos, Markus W Buchler, Oliver Strobel, Matthias Legominski, Maximilian Dietrich, Ulf Hinz, Thorsten Brenner, A. Heininger, Markus A. Weigand, Thilo HackertAbstract:Background Postoperative Pancreatic Fistula is a dangerous complication in Pancreatic surgery. This study assessed the impact of microbiologic pathogens detected in postoperative Pancreatic Fistula on clinical outcomes after partial pancreatoduodenectomy and distal pancreatectomy. Methods Microorganisms in postoperative Pancreatic Fistula were identified by microbiologic analyses from abdominal drains or intraoperative swabs during relaparotomy. Demographic, operative, and microbiologic data, as well as postoperative outcomes were examined. Results Of 2,752 patients undergoing partial pancreatoduodenectomy and distal pancreatectomy, 256 patients with clinically relevant postoperative Pancreatic Fistula (International Study Group of Pancreatic Surgery [ISGPS] grades B and C) were identified (9.3%) and microbiologic cultures were positive in 210 patients (82.0%), with a higher rate after partial pancreatoduodenectomy (95.8%) than after distal pancreatectomy (64.3%; P P = .009), sepsis (38.1% vs 6.5%; P P = .001), reoperation (48.1% vs 10.9%; P P P = .013) and was identified as an independent risk factor for sepsis, wound infection, and reoperation in the multivariate analysis. Conclusion Detection of microorganisms in postoperative Pancreatic Fistula is frequent after Pancreatic resection and indicates a turning point in the development of postoperative Pancreatic Fistula into a life-threatening condition. Whether early anti-infective therapy in combination with interventional measures or a surgical reintervention are warranted, has yet to be elucidated.
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postoperative Pancreatic Fistula
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, 2011Co-Authors: Thilo Hackert, Jens Werner, Markus W BuchlerAbstract:Abstract Postoperative Pancreatic Fistula is an important complication after Pancreatic resection. The frequency of its incidence varies between 3% after Pancreatic head resections and up to 30% following distal pancreatectomy. In recent years, the international definition of Pancreatic Fistula has been standardised according to the approach of the International Study Group on Pancreatic Fistula (ISGPF). Consequently, results from different studies have become comparable and the historically reported Fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, Fistula-associated complications and management of postoperative Pancreatic Fistula.
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Pancreatic Fistula after Pancreatic head resection
British Journal of Surgery, 2000Co-Authors: Markus W Buchler, Helmut Friess, Markus Wagner, Christoph Kulli, V Wagener, K ZgraggenAbstract:Background Pancreatic resections can be performed with great safety. However, the morbidity rate is reported to be 40–60 per cent with a high prevalence of Pancreatic complications. The aim of this study was to analyse complications after Pancreatic head resection, with particular attention to morbidity and Pancreatic Fistula. Methods From November 1993 to May 1999, perioperative and postoperative data from 331 consecutive patients undergoing Pancreatic head resection were recorded prospectively. Data were analysed and grouped according to the procedure performed: classic Whipple resection, pylorus-preserving pancreatoduodenectomy (PPPD) or duodenum-preserving Pancreatic head resection (DPPHR). Results Pancreatic head resection had a mortality rate of 2·1 per cent; the difference in mortality rate between the three groups (0·9–3·0 per cent) was not significant. Total and local morbidity rates were 38·4 and 28 per cent respectively. DPPHR had a lower morbidity, both local and systemic, than pancreatoduodenectomy. The prevalence of Pancreatic Fistula was 2·1 per cent in 331 patients, and was not dependent on the procedure or the aetiology of the disease. Reoperations were performed in 3·9 per cent of patients, predominantly for bleeding and non-Pancreatic Fistula. None of the patients with Pancreatic Fistula required reoperation or died in the postoperative course. Conclusion A standardized technique and a continuing effort to improve perioperative management may be responsible for low mortality and surgical morbidity rates after Pancreatic head resection. Pancreatic complications occur with Whipple, PPPD and DPPHR procedures with a similar prevalence. Pancreatic Fistula no longer seems to be a major problem after Pancreatic head resection and rarely necessitates surgical treatment. © 2000 British Journal of Surgery Society Ltd
Charles M Vollmer - One of the best experts on this subject based on the ideXlab platform.
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Predictive factors for Pancreatic Fistula following pancreatectomy
Langenbeck's Archives of Surgery, 2014Co-Authors: Matthew T Mcmillan, Charles M VollmerAbstract:Background Postoperative Pancreatic Fistula is a significant contributor to morbidity following proximal and distal Pancreatic resections. In recent decades, the incidence of Fistula has ranged from 2 to 33 %; however, the consistent identification of risk factors has been difficult due to significant variability in the definition of Pancreatic Fistula. Purpose The purpose of this study was to use the highest level evidence available in the literature to present risk factors thus far identified as significant predictors of Fistula occurrence. Another endpoint will address those risk factors which have been shown to have a clinical impact on the patient. This review will conclude by discussing comprehensive risk models that interpret the aggregate Fistula risk for a patient based on the presence of weighted risk factors. Conclusion The contemporary surgical literature suggests many risk factors for Fistula development, which can be categorized as either endogenous, operative, or perioperative. The advent of the International Study Group of Pancreatic Fistula (ISGPF) scheme created universal definitions for Fistula that delineate between biochemical and clinically relevant Fistulas. This classification system has allowed for the elucidation of risk factors for clinically impactful Fistula and enabled the development of risk scores for predicting Fistula occurrence after major Pancreatic resections, which are useful in clinical management and comparative research.
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predictive factors for Pancreatic Fistula following pancreatectomy
Langenbeck's Archives of Surgery, 2014Co-Authors: Matthew T Mcmillan, Charles M VollmerAbstract:Background Postoperative Pancreatic Fistula is a significant contributor to morbidity following proximal and distal Pancreatic resections. In recent decades, the incidence of Fistula has ranged from 2 to 33 %; however, the consistent identification of risk factors has been difficult due to significant variability in the definition of Pancreatic Fistula.
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risk prediction for development of Pancreatic Fistula using the isgpf classification scheme
World Journal of Surgery, 2008Co-Authors: Wande B Pratt, Mark P Callery, Charles M VollmerAbstract:Background: The International Study Group on Pancreatic Fistula (ISGPF) classification scheme has become a useful system for characterizing the clinical impact of Pancreatic Fistula. We sought to identify predictive factors that predispose patients to Fistula, specifically those with clinical relevance (grades B/C), and to describe the clinical and economic significance of risk stratification within this framework.
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clinical and economic validation of the international study group of Pancreatic Fistula isgpf classification scheme
Annals of Surgery, 2007Co-Authors: Wande B Pratt, Mark P Callery, Shishir K Maithel, Tsafrir Vanounou, Zhen S Huang, Charles M VollmerAbstract:Pancreatic Fistula is widely regarded as the most ominous of complications following Pancreatic resection. Its clinical impact and sequelae have been previously described and shown to contribute to the development of other morbid complications and high rates of mortality.1–4 Despite refinements in operative technique and advancements in postoperative management, Fistulas still occur with a frequency of 5% to 30%.5–12 Efforts to mitigate this problem have included technical considerations (modification of the Pancreatico-jejunal anastomosis technique, reconstruction with Pancreaticogastrostomy, and placement of Pancreatic duct stents), perioperative infusion of somatostatin analogues, and use of adhesive sealants.9 However, the successes of these various techniques and pharmacologic adjuvants is frequently challenged, and dissension exists as to which methods are optimal for prevention and management of Fistulas. The debate is further compounded by numerous and widely varying definitions of Pancreatic Fistula. Data from a recent analysis of 4 widely accepted definitions of Fistula reported in the gastrointestinal surgical literature demonstrates that Fistula rate depends largely upon the definition used.13 The lack of a universal definition of Pancreatic Fistula, therefore, precludes objective comparisons of surgical experiences with this complication. To address this problem and develop a consensus approach, an international consortium of 37 leading Pancreatic surgeons from 15 countries, the International Study Group on Pancreatic Fistula (ISGPF), convened, reviewed the literature, and discussed their surgical experiences with Fistulas.14 The result was a universal and applicable definition of Pancreatic Fistula and a grading system for Fistula severity based on clinical impact on the patient. Appraisal of this grading system has yet to be accomplished, and to date, the ISGPF clinical classification scheme has not been rigorously tested or validated. The aims of this study, therefore, are: 1) to analyze our experience with Pancreatic Fistula by applying the ISGPF classification scheme in a high-volume Pancreatico-biliary surgical specialty unit; 2) to demonstrate its value in examining outcomes in a large cohort of patients undergoing Pancreaticoduodenectomy; and 3) to validate its application, clinically and economically, as a suitable alternative to current biochemical definitions of Fistula.
Masao Tanaka - One of the best experts on this subject based on the ideXlab platform.
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prolonged peri firing compression with a linear stapler prevents Pancreatic Fistula in laparoscopic distal pancreatectomy
Surgical Endoscopy and Other Interventional Techniques, 2011Co-Authors: Masafumi Nakamura, Junji Ueda, Hiroshi Kohno, Shunichi Takahata, Shuji Shimizu, Masao TanakaAbstract:Background Laparoscopic distal pancreatectomy (Lap-DP) is one of the most accepted laparoscopic procedures in the field of Pancreatic surgery. However, Pancreatic Fistula remains a major and frequent complication in Lap-DP, as in open surgery. The aim of this retrospective study is to clarify the advantages of prolonged peri-firing compression (PFC) with a linear stapler for prevention of Pancreatic Fistula after laparoscopic distal pancreatectomy.
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risk analysis of Pancreatic Fistula after Pancreatic head resection
Archives of Surgery, 1998Co-Authors: Norihiro Sato, Koji Yamaguchi, Kazuo Chijiiwa, Masao TanakaAbstract:Objective To evaluate the risk factors for Pancreatic Fistula after Pancreatic head resection. Design Retrospective review. Setting University hospital, in the 71-month period from January 1992 through November 1997. Patients and Intervention Sixty-two patients who underwent Pancreatic head resection with pancreatojejunostomy. We performed an extensive analysis of preoperative and perioperative risk factors for Pancreatic Fistula. Main Outcome Measures Pancreatic Fistula was defined as high amylase level (>1000 U/L) in the drainage fluid collected from the periPancreatic drains and/or anastomotic disruption demonstrated radiographically. Results Nine (15%) of the 62 patients developed Pancreatic Fistula, and 1 (1.6%) died of intra-abdominal hemorrhage related to the Pancreatic Fistula. A preoperative normal N -benzoyl-L-tyrosyl- p -aminobenzoic acid test result ( P =.01), soft or intermediate Pancreatic consistency ( P =.04), duodenum-preserving Pancreatic head resection for the normal exocrine pancreas ( P =.002), and a larger amount of postoperative Pancreatic juice output ( P =.02) were significant risk factors for Pancreatic Fistula formation. Conclusions Careful attention should be paid to the preoperative exocrine Pancreatic function, Pancreatic consistency at surgery, and postoperative Pancreatic juice output to predict and prevent Pancreatic Fistula after Pancreatic head resection.
Keith D Lillemoe - One of the best experts on this subject based on the ideXlab platform.
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persistent Pancreatic Fistula
2015Co-Authors: Purvi Parikh, Keith D LillemoeAbstract:Pancreatic Fistula is defined as the leakage of Pancreatic fluid from a Pancreatic duct disruption either after a Pancreatic resection or from acute or chronic pancreatitis. The frequency of Fistula incidence varies between 2 and 50 %. In recent years, the international definition of Pancreatic Fistula has been standardized according to the approach of the International Study Group on Pancreatic Fistula (ISGPF). The management of Pancreatic Fistula can be complex and mandates a multidisciplinary approach. The basic principle of care including Fistula control/patient stabilization, delineation of Pancreatic duct anatomy, and definitive therapy remain of vital importance.
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Pancreatic Fistula following Pancreaticoduodenectomy clinical predictors and patient outcomes
Hpb Surgery, 2009Co-Authors: Max C Schmidt, Henry A Pitt, Attila Nakeeb, Nicholas J Zyromski, Jennifer N Choi, Emilie S Powell, Constantin T Yiannoutsos, Eric A Wiebke, James A Madura, Keith D LillemoeAbstract: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.
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fatty pancreas a factor in postoperative Pancreatic Fistula
Annals of Surgery, 2007Co-Authors: Abhishek Mathur, Henry A Pitt, Megan B Marine, Romil Saxena, Max C Schmidt, Thomas J Howard, Attila Nakeeb, Nicholas J Zyromski, Keith D LillemoeAbstract:Objective: To determine whether patients who develop a Pancreatic Fistula after pancreatoduodenectomy are more likely to have Pancreatic fat than matched controls. Background: Pancreatic Fistula continues to be a major cause of postoperative morbidity and increased length of stay after pancreatoduodenectomy. Factors associated with postoperative Pancreatic Fistula include a soft pancreas, a small Pancreatic duct, the underlying Pancreatic pathology, the regional blood supply, and surgeon's experience. Fatty pancreas previously has not been considered as a contributing factor in the development of postoperative Pancreatic Fistula. Methods: Forty patients with and without a Pancreatic Fistula were identified from an Indiana University database of over 1000 patients undergoing pancreatoduodenectomy and matched for multiple parameters including age, gender, Pancreatic pathology, surgeon, and type of operation. Surgical pathology specimens from the Pancreatic neck were reviewed blindly for fat, fibrosis, vessel density, and inflammation. These parameters were scored (0-4+). Results: The Pancreatic Fistula patients were less likely (P < 0.05) to have diabetes but had significantly more intralobular (P < 0.001), interlobular (P < 0.05), and total Pancreatic fat (P < 0.001). Fistula patients were more likely to have high Pancreatic fat scores (50% vs. 13%, P < 0.001). Pancreatic fibrosis, vessel density, and duct size were lower (P < 0.001) in the Fistula patients and negative correlations (P < 0.001) existed between fat and fibrosis (R = -0.40) and blood vessel density (R = -0.15). Conclusions: These data suggest that patients with postoperative Pancreatic Fistula have (1) increased Pancreatic fat and (2) decreased Pancreatic fibrosis, blood vessel density, and duct size. Therefore, we conclude that fatty pancreas is a risk factor for postoperative Pancreatic Fistula.
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does fibrin glue sealant decrease the rate of Pancreatic Fistula after Pancreaticoduodenectomy results of a prospective randomized trial
Journal of Gastrointestinal Surgery, 2004Co-Authors: Keith D Lillemoe, John L Cameron, Kurtis A Campbell, Patricia K Sauter, Joann ColemanAbstract:Despite substantial improvements in perioperative mortality, complications, and specifically the development of a Pancreatic Fistula, remain a common occurrence after Pancreaticoduodenectomy. It was the objective of this study to evaluate the role of fibrin glue sealant as an adjunct to decrease the rate of Pancreatic Fistula after Pancreaticoduodenectomy. One hundred twenty-five patients were randomized after Pancreaticoduodenal resection only if, in the opinion of the surgeon, the Pancreaticojejunal anastomosis was at high risk for development of a Pancreatic anastomotic leak. After completion of the Pancreaticojejunal anastomosis, the patients were randomized to topical application of fibrin glue sealant to the surface of the anastomosis or no such application. The primary postoperative end points in this study were Pancreatic Fistula, total complications, death, and length of hospital stay. A total of 59 patients were randomized to the fibrin glue arm, whereas 66 patients were randomized to the control arm and did not receive fibrin glue application. The Pancreatic Fistula rate in the fibrin glue arm of the study was 26% vs. 30% in the control group (p = not significant [NS]). The mean length of postoperative stay for all patients randomized was similar (fibrin glue = 12.2 days, control = 13.6 days) and the mean length of stay for patients in whom Pancreatic Fistula developed was also not different (fibrin glue = 18.9 days, control = 21.7 days). There were no differences with respect to total complications or specific complications such as postoperative bleeding, infection, or delayed gastric emptying. These data demonstrate that the topical application of fibrin glue sealant to the surface of the Pancreatic anastomosis in this patient population undergoing high-risk Pancreaticojejunal anastomosis did not reduce the incidence of Pancreatic Fistula or total complications after Pancreaticodudodenectomy. There seems to be no benefit regarding the use of this substance in this setting.
