The value of postoperative measurement of amylase in abdominal drainage fluid after pancreatic surgery

F Branicki,H El Salhat,M Taha,S Bakathir,T Lange,F Safi

doi:10.5348/ijhpd-2012-9-oa-7

Abstract

Introduction: Clinical symptoms accompanied by a continuous increase of amylase concentration in abdominal drainage fluid and change in color of drainage fluid may indicate the presence of fistula or leakage. Aims: To investigate the clinical relevance and utility of post-operative (PO) monitoring of amylase and lipase estimations in the serum and abdominal drainage fluid following pancreatic surgery. Methods: Seventy patients (37 males, 33 females) who underwent duodenum-preserving pancreatic head resection [n=12 (GI)], pylorus preserving Whipple's procedure [n=39 (GII)], segmental resection of the body of the pancreas [n=4 (GIII)] and pancreas tail/body resection [n=15] were enrolled in the study prospectively. In G I, II and III (n=55) duct mucosa anastomosis with the remnant of distal pancreas was fashioned. The serum amylase and lipase levels and levels of amylase in drainage fluid were measured pre-operatively and from PO day 1, until removal of the drain. Only 32 patients received subcutaneous octreotide, 100 μg three times daily for five days. Results: Elevation of serum amylase (2:100 IU/I) was found in 20/52 (38%) patients following pancreatic surgery. The elevated amylase levels returned to normal within four days. Abdominal drainage fluid amylase values were found increased in 19/47 (40%) of patients. All elevated levels returned to normal by the tenth post-operative day. The color of abdominal drainage fluid was serosanguinous in all cases. No clinical pancreatic fistula or anastomotic leakage was evident (0/55 patients), all patients were discharged home. Conclusion: Documentation of transient elevation of serum amylase and abdominal drainage fluid amylase levels did not appear to be of clinical significance.

Highlights

Clinical symptoms accompanied by a continuous increase of amylase concentration in abdominal drainage fluid and change in color of drainage fluid may indicate the presence of fistula or leakage
Failure of the remnant proximal pancreatic duct closure after left sided pancreatic resection causes milder complications as compared to anastomotic failure of an enteroentero anastomosis but it can result in fistula formation or an intraabdominal fluid collection [1]
The major cause of mortality is sepsis and/or hemorrhage resulting from failure of pancreaticojejuno or gastrostomosis [8]. To prevent this life threatening complication after surgery, various modifications for pancreaticoenteric reconstruction have been proposed like pancreaticojejunostomy or pancreaticogastrostomy, invagination or duct to mucosa anastomosis, stented or nonstented anastomosis, end to end or end to side anastomosis and the use of fibrin glue

Summary

Introduction

Clinical symptoms accompanied by a continuous increase of amylase concentration in abdominal drainage fluid and change in color of drainage fluid may indicate the presence of fistula or leakage. Aims: To investigate the clinical relevance and utility of postoperative (PO) monitoring of amylase and lipase estimations in the serum and abdominal drainage fluid following pancreatic surgery. The mortality rate after pancreatic resection has decreased to less than 5% but reported morbidity remains high [1]. Fistula rate after resection is 0–20% with a morbidity of 0–13% [1]. The main cause of serious morbidity and mortality is postoperative anastomotic leakage due to intra peritoneal release of enterokinases and activation of pancreatic enzymes that lead to sepsis and hemorrhagic complications. Failure of the remnant proximal pancreatic duct closure after left sided pancreatic resection causes milder complications as compared to anastomotic failure of an enteroentero anastomosis but it can result in fistula formation or an intraabdominal fluid collection [1]

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