Management of pancreaticopleural fistulas secondary to pancreatitis: A systematic review

BACKGROUND AND AIM: Pancreaticopleural fistulas (PPFs) are a rare complication of pancreatitis, involving an abnormal connection between the pancreas and pleural cavity. These fistulas present with respiratory symptoms, particularly pleural effusions, and pose challenges due to their rarity and overlap with other pleural pathologies. This study aims to systematically review and compare the success rates of conservative and surgical management of pancreaticopleural fistulas. METHODS: A systematic review was conducted following PRISMA guidelines, including 6 studies with 157 patients with pancreaticopleural fistulas secondary to pancreatitis. Conservative treatment included medical and endoscopic therapy, while operative management involved fistula repair and pancreatic resections. RESULTS: Of the 157 patients, 80.7% were male, and chronic alcoholism was identified as the primary cause in 58% of cases. Fistulas primarily originated from the pancreatic body or tail. Success rates were 16.49% for medical therapy, 79.2% for endoscopic treatment, and 98.76% for surgery, with 80 out of 81 surgical cases successfully resolved. Two mortalities were reported, including one postoperative death. Prolonged conservative treatment led to complications such as pleural empyema. Recurrence occurred in 1.88% of endoscopic cases, with no recurrences following surgery. CONCLUSION: This study highlights the importance of individualized treatment for patients with PPFs secondary to pancreatitis. It is recommended to approach PPF management initially via a combination of medical and endoscopic therapy, especially in specialized centers, as the latter has emerged as an affordable and effective alternative. However, if conservative therapy is inadequate, timely surgical intervention is crucial to prevent unwanted complications.