Techniques for prevention of pancreatic leak after pancreatectomy

Pancreatic resections are some of the most technically challenging operations performed bysurgeons, and post-operative pancreatic fistula (POPF) are not uncommon, developing in approximately13% of pancreaticoduodenectomies and 30% of distal pancreatectomies. Multiple trials of various operativetechniques in the creation of the pancreatic ductal anastomosis have been conducted throughout theyears, and herein we review the literature and outcomes data regarding these techniques, although no onetechnique of pancreatic ductal anastomosis has been shown to be superior in decreasing rate of POPF.Similarly, we review the literature regarding techniques of pancreatic closure after distal pancreatectomy.Again, no one technique has been shown to be superior in preventing POPF; however the use of buttressingmaterial on the pancreatic staple line in the future may be a successful means of decreasing POPF. We reviewadjunctive techniques to decrease POPF such as pancreatic ductal stenting, the use of various topical biologicglues, and the use of somatostatin analogue medications. We conclude that future trials will need to beconducted to find optimal techniques to decrease POPF, and meticulous attention to intra-operative detailsand post-operative care by surgeons is necessary to prevent POPF and optimally care for patients undergoingpancreatic resection.