HYPOTHESIS: Completion pancreatectomy in patients with pancreatic leakage associated with postoperative peritonitis after pancreaticoduodenectomy is a viable salvage procedure. DESIGN: Retrospective analysis from a cohort of consecutive patients admitted between January 1, 1989, and December 31, 1999, for postoperative peritonitis originating from pancreaticojejunostomy leakage. SETTING: Tertiary referral center with surgical intensive care unit specializing in the treatment of intra-abdominal sepsis. PATIENTS: Eight consecutive patients with postoperative peritonitis originating from pancreaticojejunostomy after pancreaticoduodenectomy, with a mean Acute Physiology and Chronic Health Evaluation II score of 18.6. We excluded patients with pancreatic fistulas or abscesses amenable to percutaneous drainage or other conservative treatment. INTERVENTION: Completion pancreatectomy. MAIN OUTCOME MEASURES: Mortality, morbidity, and long-term outcome, which was assessed by interview. RESULTS: Three patients died in the postoperative period: 2 required early reoperation during the postoperative period and died of hemorrhage and sepsis, and 1 died of multiorgan failure without reoperation. Recurrence of carcinoma was responsible for late death of 2 other patients. CONCLUSIONS: Postoperative peritonitis after pancreaticoduodenectomy still has high mortality; however, completion pancreatectomy may represent the only means to achieve source control of infection in cases of postoperative peritonitis.
HYPOTHESIS: Completion pancreatectomy in patients with pancreatic leakage associated with postoperative peritonitis after pancreaticoduodenectomy is a viable salvage procedure. DESIGN: Retrospective analysis from a cohort of consecutive patients admitted between January 1, 1989, and December 31, 1999, for postoperative peritonitis originating from pancreaticojejunostomy leakage. SETTING: Tertiary referral center with surgical intensive care unit specializing in the treatment of intra-abdominal sepsis. PATIENTS: Eight consecutive patients with postoperative peritonitis originating from pancreaticojejunostomy after pancreaticoduodenectomy, with a mean Acute Physiology and Chronic Health Evaluation II score of 18.6. We excluded patients with pancreatic fistulas or abscesses amenable to percutaneous drainage or other conservative treatment. INTERVENTION: Completion pancreatectomy. MAIN OUTCOME MEASURES: Mortality, morbidity, and long-term outcome, which was assessed by interview. RESULTS: Three patients died in the postoperative period: 2 required early reoperation during the postoperative period and died of hemorrhage and sepsis, and 1 died of multiorgan failure without reoperation. Recurrence of carcinoma was responsible for late death of 2 other patients. CONCLUSIONS:Postoperative peritonitis after pancreaticoduodenectomy still has high mortality; however, completion pancreatectomy may represent the only means to achieve source control of infection in cases of postoperative peritonitis.
Authors: F Jasmijn Smits; Hjalmar C van Santvoort; Marc G Besselink; Marilot C T Batenburg; Robbert A E Slooff; Djamila Boerma; Olivier R Busch; Peter P L O Coene; Ronald M van Dam; David P J van Dijk; Casper H J van Eijck; Sebastiaan Festen; Erwin van der Harst; Ignace H J T de Hingh; Koert P de Jong; Johanna A M G Tol; Inne H M Borel Rinkes; I Quintus Molenaar Journal: JAMA Surg Date: 2017-06-01 Impact factor: 14.766