Treatment of Postoperative Pancreatic Fistula with Somatostatin Analogue

Yuzo Fujii, Kouichi Kozaki, Hiroshi Shimizu, Yasutaka Takeda, Yoshiyuki Saegusa, Toshihiko Yoneto, Masazumi Eriguchi, Morimasa Sekiguchi

Department of Surgery, Institute of Medical Science Hospital, University of Tokyo

Five patients (four with postoperative pancreatic fistulas and one receiving prophylactic treatment after post-pancreatoduodenectomy) were treated with a synthetic peptide (Sandostatin^®) that mimics the action of somatostatin, a hormone which inhibits basal and stimulated pancreatic secretion. Two of the five patients developed fistulas after resection of the pancreatic head necessitated by periampullary malignancies, two others developed such fistulas after resection of the caudal pancreas for pancreatic or gastric cancer, whereas the remaining one was treated with Sandostatin^® for prophylactic purposes. One hundred or 200 µg of Sandostatin^® was administered daily for 5 to 15 days. All fistulas closed 3 to 27 days after the treatment. By 3 days after initiation of therapy, the mean output of pancreatic juice of the three patients after pancreatoduodenectomy decreased to 44%, 48% and 68%. During treatment, transient hyperglycemia and a slight decrease in the serum amylase were observed, but plasma levels of gastrin, glucagon, insulin, lipase, GOT, GPT, AlP, LDH, Na, K, Cl, Ca and P were unchanged. Toxic reactions were limited to mild nausea and vomiting. These results revealed that somatostatin may be useful in the treatment of pancreatic fistulas and may be efficacious as a prophylactic agent for prevention of postoperative pancreatic fistula formation.

Key words
post-operative pancreatic fistula, somatostatin, hyperalimentation

Reprint requests
Yuzo Fujii Department of Surgery, Institute of Medical Science Hospital, University of Tokyo
4-6-1, Shirokanedai, Minatoku, Tokyo, 108 JAPAN

Accepted
November 11, 1992

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