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BACKGROUND Optimal treatment strategies for patients with external pancreatic fistulas have evolved with improved radiographic imaging and the development of transpapillary pancreatic duct stents. The aim of this study was to examine factors affecting fistula closure and develop a classification scheme to guide therapeutic interventions. METHODS Retrospective chart review was made of all patients with external pancreatic fistulas treated at our institution from January 1991 to January 1997. Side (partial) fistulas maintained continuity with the gastrointestinal tract; end (complete) fistulas had no continuity with the gastrointestinal tract. RESULTS Postoperative side fistulas resolved with medical treatment in 13 (86%) of 15 patients after a mean of 11 weeks of conservative management. Inflammatory side fistulas resolved with medical treatment in only 8 (53%) of 15 patients after a mean of 22 weeks; those that did not close initially did so with transpapillary stenting. End pancreatic fistulas never closed with medical treatment and were unable to be stented; therefore internal drainage or pancreatic resection was necessary to achieve closure. There were no differences in sepsis rates, Acute Physiology and Chronic Health Evaluation II scores, fistula site, total parenteral nutrition, somatostatin treatment, or initial fistula output between groups. CONCLUSIONS Classifying external pancreatic fistulas as to their pancreatic duct relationship and cause provides important prognostic and therapeutic information.
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
January 1982,
Khirurgiia,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
January 2002,
Likars'ka sprava,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
November 1982,
Klinicheskaia khirurgiia,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
April 2001,
Endoscopy,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
January 1980,
Anesthesie, analgesie, reanimation,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
March 1977,
International surgery,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
January 2017,
Khirurgiia,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
April 1965,
Vestnik khirurgii imeni I. I. Grekova,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
March 1974,
Khirurgiia,
T J Howard, and
C E Stonerock, and
J Sarkar, and
G A Lehman, and
S Sherman, and
E A Wiebke, and
J A Madura, and
T A Broadie
May 1982,
Minerva chirurgica,
