Short Communication - (2022) Volume 23, Issue 12
Received: 03-Dec-2022, Manuscript No. 15320; Editor assigned: 05-Dec-2022, Pre QC No. 15320; Reviewed: 15-Dec-2022, QC No. 15320; Revised: 16-Dec-2022, Manuscript No. 15320; Published: 23-Dec-2022, DOI: 10.35841/1590-8577- 23.12.781
In pancreatic disease, trauma, and surgery, pancreatic fistula still pose a serious hazard. Surgery remains a crucial component of treatment despite the fact that it has received very little attention in the literature, despite the fact that improved diagnostic and treatment methods, particularly endoscopic procedures, have led to noticeably better outcomes. A soft pancreatic texture and a major pancreatic duct diameter of 3 mm or less have been identified as the two most significant risk factors. Anastomotic leakage prevention has been researched using a variety of surgical procedures, but none have been proven to be more effective than others. Somatostatin analogue use is still a contentious topic. The majority of the time, conservative care of Postoperative pancreatic fistula is successful, however surgical management may be required in patients with sepsis and a deteriorating clinical condition. Percutaneous endoscopic gastrostomy was developed as an alternative to conventional surgical techniques. With percutaneous approaches, the reported morbidity and death rates have been at least as good as those for operational treatments. Patient acceptance has been high while costs have been lower.
Internal Pancreatic Fistula (IPF) is a complicated condition with a variety of aetiologies, clinical manifestations, and treatment options. IPF lacks standards for management and categorization, in contrast to postoperative pancreatic fistula. Randomized control trials are unusual due to the disease's rarity, which also makes it challenging to develop guidelines. As a result, there are now various methods for managing IPF. Treatment for IPF that is linked to both acute and chronic pancreatitis involves a step-up process. Morbidity increases when chronic pancreatitis-related IPF is treated using the conventional step-up method. The morbidity is increased by prolonged fasting, pancreatic fluid drainage, and prolonged hospital stays. Early surgical surgery can simultaneously address the fistula and underlying disease processes in patients with IPF and chronic pancreatitis. This might result in a shorter hospital stay and lower morbidity [1].
The complications of acute or chronic pancreatitis might include pancreatic fistulas. Pancreatic fistulas can also be caused by trauma or iatrogenic damage to the duct after surgery on the pancreas or surrounding organs, endoscopic intervention, or percutaneous procedures. There are insufficient standards for the classification and therapy of internal pancreatic fistulas, in contrast to postoperative exterior pancreatic fistulas (IPFs) [2]. Pancreatic ascites, pancreatic pleural effusion, mediastinal effusion, bronchial effusion, pancreaticocardial or pancreaticoenteric fistulas, and, in rare cases, pancreaticobiliary or pancreaticoportal fistulas are some of the possible symptoms of IPFs. Pancreatic duct disruptions that are not contained can result in internal fistulas. Less frequently, IPFs might develop as a result of a pseudocyst rupture or leak. 7-8% of people with chronic pancreatitis and 1% of people with acute pancreatitis have an IPF [3]. Any patient with ascites or a significant pleural effusion in addition to acute or chronic pancreatitis should have IPFs suspected. Drainage is indicated when conservative therapy fails as seen by recurrence or the appearance of new symptoms. Pancreatic fistulas can be closed more easily thanks to endoscopic retrograde cholangiopancreatography (ERCP), which can lower pressure inside the pancreatic duct. Because pancreatic fistulas are a rare disease entity, a multidisciplinary approach is necessary. Different categories are used to classify pancreatic fistulas. They can be categorised as internal or external in terms of anatomy, or as low-output (>200 mL) or high-output (200 mL) fistulas in terms of fluid output [4]. Additionally, they can be categorised etiologically as fistulas connected to either acute or chronic pancreatitis. Finally, they can be divided into simple (having only one tract) and complex (more than one tract). Patients with pancreatic pleural effusion frequently have chest symptoms as dyspnea, coughing, and pain in the chest. Nutritional malnutrition, electrolyte imbalance, skin excoriation, infection, and, in rare instances, bleeding are all side effects of pancreatic fistulas. Lower recurrence, morbidity, and cost rates were linked to early surgical intervention. It addressed the main cause and led to a quicker remission of symptoms. In the standard intervention group, hospital stays lasted 8–14 weeks as opposed to 8–10 days in the early surgical intervention group [5].
IPFs are linked to high rates of morbidity but low overall death rates. Early surgical intervention may be essential in altering the clinical course and addressing the fundamental disease of the pancreas since it may be a contributing reason to high morbidity rates. To build a uniform approach, randomised control studies should be used to further analyse the advantages and drawbacks of conventional therapy and surgical intervention.
Indexed at, Google Scholar, Cross Ref
Indexed at, Google Scholar, Cross Ref
Indexed at, Google Scholar, Cross Ref
Indexed at, Google Scholar, Cross Ref
Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
