Background: The role of somatostatin and its analogues in reducing complications after pancreatic resection is controversial. This is a meta‐analysis of the evidence of benefit. Methods: A literature search using Medline and ISI Proceedings with exploration of the references identified 22 studies. Of these, ten met the inclusion criteria for data extraction. Estimates of effectiveness were performed using fixed‐ and random‐effects models. The effect was calculated as an odds ratio (OR) with 95 per cent confidence intervals (c.i.) using the Mantel–Haenszel method. Level of significance was set at P < 0·050. Results: Outcomes for 1918 patients were compared. Somatostatin and its analogues did not reduce the mortality rate after pancreatic surgery (OR 1·17 (0·70 to 1·94); P = 0·545) but did reduce both the total morbidity (OR 0·62 (0·46 to 0·85); P = 0·003) and pancreas‐specific complications (OR 0·56 (0·39 to 0·81); P = 0·002). Somatostatin and its analogues reduced the rate of biochemical fistula (OR 0·45 (0·33 to 0·62); P < 0·001) but not the incidence of clinical anastomotic disruption (OR 0·80 (0·44 to 1·45); P = 0·459). Conclusion: Somatostatin and its analogues reduce the incidence of complications after surgery. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.