Vikrom K Dhar1, Jeffrey M Sutton1, Brent T Xia1, Nick C Levinsky1, Gregory C Wilson1, Milton Smith2, Kyuran A Choe3, Jonathan Moulton3, Doan Vu3, Ross Ristagno3, Jeffrey J Sussman1, Michael J Edwards1, Daniel E Abbott4, Syed A Ahmad5. 1. Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA. 2. Department of Medicine, Division of Gastroenterology, University of Cincinnati, Cincinnati, OH, USA. 3. Department of Radiology, University of Cincinnati, Cincinnati, OH, USA. 4. Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI, USA. 5. Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA. ahmadsy@uc.edu.
Abstract
BACKGROUND: A disconnected distal pancreas (DDP) remnant is a morbid sequela of necrotizing pancreatitis. Definitive surgical management can be accomplished by either fistulojejunostomy (FJ) or distal pancreatectomy (DP). It is unclear which operative approach is superior with regard to short- and long-term outcomes. METHODS: Between 2002 and 2014, patients undergoing either FJ or DP for DDP were retrospectively identified at a center specializing in pancreatic diseases. Patient demographics, perioperative, and postoperative variables were evaluated. RESULTS: Forty-two patients with DDP secondary to necrotizing pancreatitis underwent either a FJ (n = 21) or DP (n = 21). Between the two cohorts, there were no significant differences in overall lengths of stay, pancreatic leak rates, or readmission rates (all p > 0.05). DP was associated with higher estimated blood loss, increased transfusion requirements, and worsening endocrine function (all p < 0.05). At a median follow-up of 18 months, four patients that underwent a FJ developed a recurrent fluid collection requiring re-intervention. Overall, FJ was successful in 80% of patients as compared to a 95% success rate for DP (p = 0.15). CONCLUSIONS: Although DP was associated with higher intraoperative blood loss, increased transfusion requirements, and worsening of preoperative diabetes, this procedure provides superior long-term resolution of a DDP when compared to FJ.
BACKGROUND: A disconnected distal pancreas (DDP) remnant is a morbid sequela of necrotizing pancreatitis. Definitive surgical management can be accomplished by either fistulojejunostomy (FJ) or distal pancreatectomy (DP). It is unclear which operative approach is superior with regard to short- and long-term outcomes. METHODS: Between 2002 and 2014, patients undergoing either FJ or DP for DDP were retrospectively identified at a center specializing in pancreatic diseases. Patient demographics, perioperative, and postoperative variables were evaluated. RESULTS: Forty-two patients with DDP secondary to necrotizing pancreatitis underwent either a FJ (n = 21) or DP (n = 21). Between the two cohorts, there were no significant differences in overall lengths of stay, pancreatic leak rates, or readmission rates (all p > 0.05). DP was associated with higher estimated blood loss, increased transfusion requirements, and worsening endocrine function (all p < 0.05). At a median follow-up of 18 months, four patients that underwent a FJ developed a recurrent fluid collection requiring re-intervention. Overall, FJ was successful in 80% of patients as compared to a 95% success rate for DP (p = 0.15). CONCLUSIONS: Although DP was associated with higher intraoperative blood loss, increased transfusion requirements, and worsening of preoperative diabetes, this procedure provides superior long-term resolution of a DDP when compared to FJ.
Authors: J M Ramia; R de la Plaza; J E Quiñones-Sampedro; C Ramiro; P Veguillas; J García-Parreño Journal: Neth J Med Date: 2012-05 Impact factor: 1.422
Authors: Guru Trikudanathan; Mustafa Arain; Rajeev Attam; Martin L Freeman Journal: Expert Rev Gastroenterol Hepatol Date: 2013-07 Impact factor: 3.869
Authors: Shayan Irani; Michael Gluck; Andrew Ross; S Ian Gan; Robert Crane; John J Brandabur; Ellen Hauptmann; Mehran Fotoohi; Richard A Kozarek Journal: Gastrointest Endosc Date: 2012-09 Impact factor: 9.427
Authors: Kariuki P Murage; Chad G Ball; Nicholas J Zyromski; Attila Nakeeb; Carlos Ocampo; Kumaresan Sandrasegaran; Thomas J Howard Journal: Surgery Date: 2010-08-24 Impact factor: 3.982
Authors: Mario Pelaez-Luna; Santhi Swaroop Vege; Bret T Petersen; Suresh T Chari; Jonathan E Clain; Michael J Levy; Randal K Pearson; Mark D Topazian; Michael B Farnell; Michael L Kendrick; Todd H Baron Journal: Gastrointest Endosc Date: 2008-04-18 Impact factor: 9.427
Authors: Martin L Freeman; Jens Werner; Hjalmar C van Santvoort; Todd H Baron; Marc G Besselink; John A Windsor; Karen D Horvath; Eric vanSonnenberg; Thomas L Bollen; Santhi Swaroop Vege Journal: Pancreas Date: 2012-11 Impact factor: 3.327
Authors: D W da Costa; D Boerma; H C van Santvoort; K D Horvath; J Werner; C R Carter; T L Bollen; H G Gooszen; M G Besselink; O J Bakker Journal: Br J Surg Date: 2013-11-22 Impact factor: 6.939