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Stent does not prevent leaks after distal pancreatectomy

NEW YORK (Reuters Health) – Transpapillary stents do not prevent clinically significant leaks after distal pancreatectomy, according to researchers from Sweden.

Based on the notion that downstream deviation of pancreatic juice might significantly decrease pancreatic fistulas, Dr. Farshad Frozanpor and colleagues from Karolinska Institutet in Stockholm designed a randomized trial to test the effect of pancreatic duct stenting on fistula and complication rates after a standardized distal pancreatectomy in 58 patients.

Pancreatic fistula developed in more patients with stents (50%) than without stents (37%), the research team reported online April 13th in Annals of Surgery.

Clinically significant pancreatic fistula (grades B and C) were also more common in patients with stents (42.3%) than in patients without stents (22.2%).

There was no relationship between stent size and pancreatic fistula risk.

Deployment of stents increased the mean operative time (from 218.8 to 284.3 min), and stented patients tended to have longer hospital stays (mean, 19.4 vs 13.4 days).

But there were no differences between the groups in overall complication rates, and there was no postoperative mortality.

“Pancreatic fistula and postoperative morbidity remain a substantial problem after distal pancreatectomy,” the researchers conclude. “‘Downstream’ control of the pancreatic duct through stent placement does not change this clinical scenario.”

SOURCE: http://bit.ly/JcY7cW

Ann Surg 2012.