Facing the surgeon's nightmare

Abstract

$\bf Background$ Postoperative pancreatic fistulas (POPF) grade C represent a rare but feared complication following pancreaticoduodenectomy (PD). They can contribute significantly to postoperative morbidity and mortality. $\bf Methods$ We performed a retrospective chart review for all patients who had undergone pancreatic head resection between 2007 and 2016 to identify those who suffered from POPF grade C according to the updated definition of the International Study Group of Pancreatic Surgery (ISGPS). $\bf Results$ A total of 722 patients underwent PD. Twenty-three patients (3.19%) developed a POPF grade C. Cardiovascular diseases, soft pancreatic texture and main pancreatic duct diameter were identified as risk factors ($\it P$ < .05). Reoperation was necessary in all affected patients on postoperative day 12 $\pm$ 9 on average. Mortality was significantly associated with POPF grade C ($\it P$ < .05) being present in 39.1% (9/23). $\bf Conclusions$ POPF grade C after PD remains a serious complication with a high level of morbidity and mortality. Surgical treatment is the sole curative therapy and thus the treatment of choice