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Salvage pancreaticogastrostomy for pancreatic fistulae after pancreaticoduodenectomy

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Abstract

Pancreatic anastomotic dehiscence after pancreaticoduodenectomy (PD) remains a common problem. Although the management of this condition is mostly conservative, some patients require surgical intervention. This study reviews our experience with surgical intervention in this clinical setting. All patients who underwent PD by the author between 1999 and 2011 were reviewed. The causes for reoperation and mortality after PD were evaluated. The nature of the operative intervention and outcome in those who underwent reoperation for postoperative pancreatic fistula were analyzed. Reoperation was necessary in a total of 36/208 patients in this series and the overall mortality for the entire series was 6.25 % (13/208). Twelve of these 36 reoperations in 208 patients were for treatment of pancreatic anastomotic dehiscence after PD. Five (42 %) patients reoperated for anastomotic dehiscence died, including four of six patients that underwent surgical drainage of percutaneously inaccessible collections and one of two patients that underwent completion pancreatectomy. None of those who underwent salvage pancreaticogastrostomy (PG) died, nor did they require additional interventions prior to discharge from hospital. In our experience, salvage PG was an effective and organ function preserving technique to manage pancreatic anastomotic dehiscence after PD.

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References

  1. Haddad LBP, Scatton O, Randone B, et al. Pancreatic fistula after pancreaticoduodenectomy: the conservative treatment of choice. HPB. 2009;11:203–9.

    Article  PubMed  Google Scholar 

  2. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  3. Kazanjian KK, Hines OJ, Eibl G, Reber HA. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 patients. Arch Surg. 2005;140:849–54.

    Article  PubMed  Google Scholar 

  4. Veillette G, Dominguez I, Ferrone C, et al. Implications and management of pancreatic fistulas after pancreaticoduodenectomy. Arch Surg. 2008;143:476–81.

    Article  PubMed  Google Scholar 

  5. Fuks D, Piessen G, Huet E, et al. Life threatening postoperative pancreatic fistula (Grade C) after pancreaticoduodenectomy: incidence, prognosis and risk factors. Am J Surg. 2009;197:702–9.

    Article  PubMed  Google Scholar 

  6. De Castro SMM, Busch ORC, van Gulik TM, Obertop H, Gouma DJ. Incidence and management of pancreatic leakage after pancreaticoduodenectomy. Br J Surg. 2005;92:1117–23.

    Article  PubMed  Google Scholar 

  7. Kent TS, Callery MP, Vollmer CM Jr. The bridge stent technique for salvage of pancreaticojejunal anastomotic dehiscence. HPB. 2010;12:577–82.

    Article  PubMed  Google Scholar 

  8. Xu J, Dai X, Bu X, Gao F, Zhang X. Pancreaticojejunal bridge anastomosis: a novel option for surgeon to preserve pancreatic body and tail in urgent reoperation for intra-abdominal massive haemorrhage after pancreaticoduodenectomy. World J Surg. 2010;34:2457–62.

    Article  PubMed  Google Scholar 

  9. Bachellier P, Oussoultzoglou E, Rosso E, et al. Pancreaticogastrostomy as a salvage procedure to treat severepostoperative pancreatic fistula after pancreaticoduodenectomy. Arch Surg. 2008;143:966–70.

    Article  PubMed  Google Scholar 

  10. Van Berge Henegouwen MI, De Wit LT, van Gulik TM, Obertop H, Gouma DJ. Incidence, risk factors and treatment of pancreatic leakage after pancreaticoduodenectomy: drainage versus resection of the pancreatic remnant. J Am Coll Surg. 1997;185:18–24.

    PubMed  Google Scholar 

  11. Munoz-Bongrand N, Sauvanet A, Denys A, Sibert A, Vilgrain V, Belghiti J. Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg. 2004;199:198–203.

    Article  PubMed  Google Scholar 

  12. Veillette G, Dominguez I, Ferrone C, et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg. 2008;143:476–81.

    Article  PubMed  Google Scholar 

  13. Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance and management. Am J Surg. 1994;168:295–8.

    Article  PubMed  CAS  Google Scholar 

  14. Shrikhande S, D’Souza M. Pancreatic fistula after pancreatectomy: evolving definitions, preventive strategies and modern management. World J Gastroenterol. 2008;14:5789–96.

    Article  PubMed  Google Scholar 

  15. Farley DR, Schwall G, Trede M. Completion pancreatectomy for surgical complications after pancreaticoduodenectomy. Br J Surg. 1996;83:176–9.

    Article  PubMed  CAS  Google Scholar 

  16. Gueroult S, Parc Y, Duron F, Paye F, Parc R. Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy. Early and late outcome. Arch Surg. 2004;139:16–9.

    Article  PubMed  Google Scholar 

  17. Benzoni E, Zompicchiatti A, Saccamano E, et al. Postoperative complication linked to pancreaticoduodenectomy. An analysis of pancreatic stump management. J Gastrointestin Liver Dis. 2008;17:43–7.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Bangalore Institute of Oncology Specialty Centre, HCG Towers, #8 P. Kalinga Rao Road, Sampangiram Nagar, Bangalore, 560 027, India

    Sanjay Govil

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  1. Sanjay Govil
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Correspondence to Sanjay Govil.

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Govil, S. Salvage pancreaticogastrostomy for pancreatic fistulae after pancreaticoduodenectomy. Indian J Gastroenterol 31, 263–266 (2012). https://doi.org/10.1007/s12664-012-0213-1

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  • DOI: https://doi.org/10.1007/s12664-012-0213-1

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