| Pancreatogastrostomy as a salvage procedure to treat severe postoperative pancreatic fistula after pancreatoduodenectomy. | |
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MedLine Citation:
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PMID: 18936375 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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HYPOTHESIS: Postoperative pancreatic fistula (POPF) is one of the most severe surgical complications of pancreatoduodenectomy (PD) with pancreaticojejunostomy (PJ) reconstruction. Recently, POPF has been classified as grade A, B, or C. Relaparotomy is mandatory for POPF associated with sepsis or hemorrhage (grade C). Peripancreatic drainage and completion pancreatectomy are the procedures most commonly used, but associated morbidity and mortality remain high. We hypothesized that the results of pancreatogastrostomy (PG) for treatment of grade C POPF following PD with PJ in the rare patients for whom relaparotomy is necessary would be similar to the results in a historical series of similar patients who underwent completion pancreatectomy. DESIGN: Case series. SETTING: Academic research. PATIENTS: Between June 1, 1988, and June 30, 2005, 403 patients underwent PD (85 with PJ and 318 with PG). During the same period, 12 patients were treated for grade C POPF, which occurred only after PD with PJ. INTERVENTIONS: All 12 patients with grade C POPF required relaparotomy. Eight patients underwent completion pancreatectomy (group A), and 4 patients underwent salvage telescoped PG with preservation of the pancreatic remnant (group B). MAIN OUTCOME MEASURES: Postoperative mortality and morbidity. RESULTS: Mortality was 50% (4 of 8 patients) in group A and 0% (0 of 4 patients) in group B. Specific and general complications and the length of hospital stay were similar in both groups. One patient in group B developed grade B POPF, which was managed nonsurgically. Postoperative diabetes mellitus occurred in all patients in group A and in 1 patient in group B. CONCLUSION: In selected patients, salvage PG can be considered a safe and efficient alternative to completion pancreatectomy for the treatment of grade C POPF after PD with PJ. |
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Authors:
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Philippe Bachellier; Elie Oussoultzoglou; Edoardo Rosso; Radu Scurtu; Ioan Lucescu; Akihiko Oshita; Daniel Jaeck |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 143 ISSN: 1538-3644 ISO Abbreviation: Arch Surg Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-10-21 Completed Date: 2008-11-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: United States |
Other Details:
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Languages: eng Pagination: 966-70; discussion 971 Citation Subset: AIM; IM |
Affiliation:
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Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hopitaux Universitaires de Strasbourg-Université Louis Pasteur, Avenue Molière, 67200 Strasbourg, France. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cohort Studies Female Follow-Up Studies Gastrostomy / methods*, mortality Humans Male Middle Aged Pancreatectomy / adverse effects, methods Pancreatic Diseases / mortality, pathology, surgery* Pancreatic Fistula / etiology, mortality, surgery* Pancreatic Neoplasms / mortality, pathology, surgery Pancreaticoduodenectomy / adverse effects*, methods Pancreaticojejunostomy / methods, mortality Postoperative Complications / mortality, surgery Probability Reoperation Retrospective Studies Risk Assessment Salvage Therapy / methods*, mortality Severity of Illness Index Splenectomy / methods Statistics, Nonparametric Survival Analysis Treatment Outcome |
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