Intractable Postoperative Pancreatic Fistula: Undefined Type of Pancreatic Fistula Managed by Puestow-Like Procedure
Bibliographic record
Abstract
Pancreatoduodenectomy (PD) is a very complex and highly challenging operation for surgeons worldwide. It is the surgical procedure of choice for the management of benign and malignant diseases of the periampullary region. Although mortality rate following this complicated surgery has fallen to 1-3%, morbidity rate following PD remains high, with almost 30-40% of patients developing at least one complication. Postoperative pancreatic fistula (POPF) is one of the most common complications following PD. Therefore, Pancreatico-enteric anastomosis has been regarded as the "Achilles heel" of the modern, one-stage PD procedure. According to the International Study Group of Pancreatic Surgery (ISGPS), three types of POPF are recognized nowadays: biochemical leak, previously known as grade A POPF, grade B and grade C, with the latter being the most dangerous. Most POPFs, especially of the biochemical leak and grade B heal with non-operative management to recur later and present as an intra-abdominal abscess or pseudocyst, necessitating management by means of interventional radiology, endoscopy or surgery. These types of fistulas are undefined and occasionally intractable. Herein, we present two patients who presented with the aforementioned type of pancreatic fistula following duct occlusion PD. The first patient, a 53-year-old female patient, suffered from intolerance to oral feeding, severe weight loss and recurrent hospital admission, while the second patient, a 72-year-old patient, suffered from recurrent bouts of abdominal sepsis. Their management involved step-up approach, starting with non-operative management, followed by percutaneous drainage and operative treatment in the form of Puestow-like procedure (longitudinal pancreatojejunostomy), as a recourse due to the inadequacy of preceding therapeutic modalities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".