One of the most common complications after distal
pancreatectomy is a
fistula from the pancreatic remnant. Factors influencing the development of a
pancreatic fistula after distal
pancreatectomy have not been clearly elucidated. The records of 91 patients who underwent distal
pancreatectomy for
chronic pancreatitis between 1995 and 2003 were retrospectively reviewed and analyzed. Average daily volume and
amylase concentration between postoperative days 2 and 20 from drains located at the pancreatic resection site were compared to clinical variables. Out of 137 pre- and intraoperative clinical variables, multivariate analysis showed serum
creatinine (t = 3.05, p = 0.004), history of intraabdominal operation (t = -2.68, p = 0.01), right-sided pancreatic duct dilation (t = 2.65, p = 0.01), synchronous
cholecystectomy (t = 2.53, p = 0.02), and
serum albumin (t = -2.19, p = 0.04) to be independently associated with drain volume. Drain
amylase concentration was linked to serum
creatinine (t = 8.55, p < 0.001), blood
urea nitrogen (t = -3.43, p = .001), preoperative
parenteral nutrition (t = 2.56, p = .01), and serum
alkaline phosphatase (t = 2.51, p = 0.01). There was no correlation between the degree of
fibrosis and drain output. Technique of pancreatic transection and presence of
suture closure of the pancreatic duct did not affect drain output. In conclusion, the amount and
amylase concentration of postsurgical drainage after distal
pancreatectomy for
chronic pancreatitis is dependent on markers of renal dysfunction,
malnutrition, biliary disease, and possibly
inflammation. These factors, if medically reversible, should be addressed in patients who are candidates for distal
pancreatectomy for
chronic pancreatitis.