Diagnosis, treatment and prophylaxis of pancreatic fistulas in severe necrotizing pancreatitis and the long-term outcome of acute pancreatitis

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, Auditorium 1

Topic of the dissertation

Diagnosis, treatment and prophylaxis of pancreatic fistulas in severe necrotizing pancreatitis and the long-term outcome of acute pancreatitis

Doctoral candidate

Medical Doctor Heikki Karjula

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Medical Research Center

Subject of study

Surgery

Opponent

Professor Ari Leppäniemi, Helsinki University hospital

Custos

Professor Jyrki Mäkelä, Oulu University hospital

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Diagnosis, treatment and prophylaxis of pancreatic fistulas in severe necrotizing pancreatitis and the long-term outcome of acute pancreatitis

Acute infected necrotizing pancreatitis (ANP) is a very complex disease with a high risk of complications and death. ANP is difficult to treat and is often associated with poor outcomes. Despite the increasing data on the technical details required to perform a mini-invasive necrosectomy for infected pancreatic necrosis, relatively few studies have focused on the presence and consequences of pancreatic fistula (PF) in the context of APN. Moreover, the long-term prognosis of patients with acute pancreatitis (AP) is scant.

The results of this study confirm that PF is common in patients after a surgical necrosectomy and the diagnosis of PF is challenging in infected situations. The results also confirm that endoscopic pancreatic ductal stenting (EPDS) is a good treatment for PF after necrosectomy, but the prevention of PF with prophylactic EPDS in ANP seems to be harmful for patients. The long-term outcome of AP, particularly alcohol AP, was associated with high mortality. This all indicates that for patients with infected ANP, a PF must be considered in the treatment, but the prevention of a pancreatic ductal leak with prophylactic stenting cannot be recommended. In addition, long-term mortality among patients with AP (mainly alcohol-induced) was four times higher than within the age-and sex-matched control population.
Last updated: 4.12.2019