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Pancreatic Leak (pancreatic + leak)

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Medical Sciences	100%

Selected Abstracts

Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2003
M. M. Bilimoria
Background: Although much is known about the long-term outcome of patients undergoing left (distal) pancreatectomy for malignancy, comparatively little is known about the optimal management strategy for the residual transected pancreatic parenchyma and the divided pancreatic duct. Clinicopathological and operative factors that may contribute to postoperative pancreatic leak were evaluated. Methods: A retrospective review of the medical records of 126 patients who underwent left pancreatectomy between June 1990 and December 1999 at the University of Texas M. D. Anderson Cancer Center was performed. Results: Indications for left pancreatectomy included pancreatic neoplasms (n = 42; 33·3 per cent), en bloc resection for management of retroperitoneal sarcoma (n = 21; 16·7 per cent), gastric adenocarcinoma (n = 14; 11·1 per cent), renal cell carcinoma (n = 11; 8·7 per cent) and other tumours or benign conditions (n = 38; 30·2 per cent). Pancreatic parenchymal closure was accomplished by a hand-sewn technique, mechanical stapling, or a combination of the two in 83, 20 and 15 patients respectively. No form of parenchymal closure was used in eight patients. Identification of the pancreatic duct and suture ligation was performed in 73 patients (57·9 per cent). Twenty-five patients (19·8 per cent) developed a pancreatic leak. For subgroups having duct ligation or no duct ligation, pancreatic leak rates were 9·6 per cent (seven of 73 patients) and 34·0 per cent (18 of 53 patients) respectively (P < 0·001). Multivariate analysis including clinicopathological and operative factors indicated that failure to ligate the pancreatic duct was the only feature associated with an increased risk for pancreatic leak (odds ratio 5·0 (95 per cent confidence interval 2·0 to 10·0); P = 0·001). Conclusion: Pancreatic leak remains a common complication after left pancreatectomy. The incidence of leak is reduced significantly when the pancreatic duct is identified and directly ligated during left pancreatectomy. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Post pancreaticoduodenectomy haemorrhage: outcome prediction based on new ISGPS Clinical severity grading

HPB, Issue 5 2008
G. Rajarathinam
Abstract Objective & background data. Mortality following pancreatoduodenectomy (PD) has fallen below 5%, yet morbidity remains between 30 and 50%. Major haemorrhage following PD makes a significant contribution to this ongoing morbidity and mortality. The aim of the present study was to validate the new International Study Group of Pancreatic Surgery (ISGPS) Clinical grading system in predicting the outcome of post pancreaticoduodenectomy haemorrhage (PPH). Material and methods. Between January 1998 and December 2007 a total of 458 patients who underwent Whipple's pancreaticoduodenectomy in our department were analysed with regard to haemorrhagic complications. The onset, location and severity of haemorrhage were classified according to the new criteria developed by an ISGPS. Risk factors for haemorrhage, management and outcome were analysed. Results. Severe PPH occurred in 14 patients (3.1%). Early haemorrhage (<24 hours) was recorded in five (36%) patients, and late haemorrhage (>24 hours) in nine (64%) patients. As per Clinical grading of ISGPS 7 (50%) belongs to Grade C and 7 (50%) belongs to Grade B. Haemostasis was attempted by surgery in 10 (71%) patients; angioembolisation was successful in two (14%) and endotherapy in one (7%) patient. The overall mortality is 29%(n=4). Age >60 years (p=0.02), sentinel bleeding (p=0.04), pancreatic leak (p=0.04) and ISGPS Clinical grade C (p=0.02) were associated with increased mortality. Conclusion. Early haemorrhage was mostly managed surgically with better outcome when endoscopy is not feasible. Late haemorrhage is associated with high mortality due to pancreatic leak and sepsis. ISGPS Clinical grading of PPH is useful in predicting the outcome. [source]

Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation

Experience of pancreaticoduodenectomy in a district general hospital

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2000
K. Akhtar
Aims: Long-term survival after surgery for pancreatic cancer remains very low and it is particularly important that minimal surgery-related morbidity and mortality rates are achieved. It has been stated that centres performing small numbers of proximal pancreaticoduodenectomies are likely to have high morbidity and mortality rates. The results of pancreatic surgery in a district general hospital are reported. Methods: This was a retrospective analysis of all pancreaticoduodenectomies over 4 years. Results: Twenty-one selected patients underwent proximal pancreaticoduodenectomy and two patients total pancreatectomy over a 4-year period from 1995 to 1999. The operations were performed by two surgeons with a special interest in upper gastrointestinal surgery. The median age was 62 (38,83) years. There were 14 men and nine women. Fifteen patients had adenocarcinoma of the head of the pancreas, five had ampullary carcinoma, one duodenal carcinoma and there was one case of chronic pancreatitis. Six patients had pylorus-preserving pancreaticoduodenectomy (PPPD) and 15 had a standard Whipple procedure. The median stay in hospital was 20 (13,26) days. Two patients had a pancreatic leak, one of whom developed an intra-abdominal abscess which was treated successfully by percutaneous drainage. Six patients experienced delayed gastric emptying, two of whom had PPPD. Both the 30-day and in-hospital mortality rates were zero. The median number of lymph nodes dissected was 12 and in 11 patients no nodal metastasis was found. Conclusions: It is possible to perform pancreatic surgery in a district general hospital and achieve results that are comparable to those of specialist centres. © 2000 British Journal of Surgery Society Ltd [source]

Defining the role of surgery for complications after pancreatoduodenectomy

ANZ JOURNAL OF SURGERY, Issue 1-2 2009
Parul J Shukla
Abstract Background:, Although mortality rates following pancreatoduodenectomy have drastically reduced over the last few decades, high morbidity rates have continued to trouble pancreatic surgeons across the world. Interventional radiology has reduced the need for re-exploration for complications following pancreatoduodenectomy. There remain specific indications for re-exploration in such scenarios. It is thus pertinent to identify those clinical scenarios where surgery still has a role in managing complications of pancreatoduodenectomy. The aim of the study was to define the role of surgery for dealing with complications following pancreatoduodenectomy. Methods:, One hundred and fifty-seven consecutive pancreatoduodenectomies carried out at a single institution between 1 January 2001 and 28 February 2007, were analysed. The database was looked into to identify patients who underwent re-exploration for complications and to define the indications for the exploration in these patients. Results:, Out of the 157 pancreatoduodenectomies, there were, in all, 39 complications (24.2%) in 38 patients. Most of these complications were successfully managed conservatively and with the help of interventional radiology. Seventeen patients had to be re-explored (10.8%). The indications were primarily for haemorrhage, clinically significant pancreatic leaks, biliary leaks, adhesive intestinal obstruction and burst abdomen. The overall mortality rate was 3.1%. The mortality rate in the patients undergoing re-exploration was 11.7%. Conclusion:, Early haemorrhage (from the pancreatic stump or anastomotic line), clinically significant pancreatic anastomotic leak with discharge from the main wound and an early biliary anastomotic leak are prime indications for re-exploration in patients with complications following pancreatoduodenectomy. [source]