AIMS: To analyze the role of different procedures in the management of pancreatic stump according to the incidence of postoperative morbidity derived from the data of a single center surgical population. METHODS: From 1989 to 2005 we performed 76 pancreaticoduodenectomies (PD) and 26 distal pancreatectomies (DP). The surgical reconstruction after PD was as follows: 11 manual non-absorbable stitches closure of the main duct, 24 closures of the main duct with linear stapler, 17 occlusions of the main duct with neoprene glue and 24 duct-to-mucosa anastomosis. RESULTS: In the PD group, the morbidity rate was 60%, caused by: pancreatic leakage in 48% of patients, hemorrhagic complications in 10% following surgical procedure and infectious complications in 15%. After DP we recorded: leakage in 3.9%, haemoperitoneum in 15.4% and no complications in 80.7%. The multivariate analysis showed that the in-hospital mortality was linked to the surgical procedure (PD, p=0.003) and to the following complications: pancreatic leakage (p=0.004), haemoperitoneum (p=0.00045) and infectious complications (p=0.0077). Bleeding complications, biliary anastomosis leakage and infectious complications were consequences of pancreatic leakage (p=0.025, p=0.025 and p=0.025 respectively). CONCLUSION: Manual non-absorbable stitch closure of the main duct and occlusion of the main duct with neoprene glue should be avoided in the reconstructive phase.
AIMS: To analyze the role of different procedures in the management of pancreatic stump according to the incidence of postoperative morbidity derived from the data of a single center surgical population. METHODS: From 1989 to 2005 we performed 76 pancreaticoduodenectomies (PD) and 26 distal pancreatectomies (DP). The surgical reconstruction after PD was as follows: 11 manual non-absorbable stitches closure of the main duct, 24 closures of the main duct with linear stapler, 17 occlusions of the main duct with neoprene glue and 24 duct-to-mucosa anastomosis. RESULTS: In the PD group, the morbidity rate was 60%, caused by: pancreatic leakage in 48% of patients, hemorrhagic complications in 10% following surgical procedure and infectious complications in 15%. After DP we recorded: leakage in 3.9%, haemoperitoneum in 15.4% and no complications in 80.7%. The multivariate analysis showed that the in-hospital mortality was linked to the surgical procedure (PD, p=0.003) and to the following complications: pancreatic leakage (p=0.004), haemoperitoneum (p=0.00045) and infectious complications (p=0.0077). Bleeding complications, biliary anastomosis leakage and infectious complications were consequences of pancreatic leakage (p=0.025, p=0.025 and p=0.025 respectively). CONCLUSION: Manual non-absorbable stitch closure of the main duct and occlusion of the main duct with neoprene glue should be avoided in the reconstructive phase.
Authors: Vincenzo Mazzaferro; Matteo Virdis; Carlo Sposito; Christian Cotsoglou; Michele Droz Dit Busset; Marco Bongini; Maria Flores; Natalie Prinzi; Jorgelina Coppa Journal: Ann Surg Date: 2019-11 Impact factor: 12.969