title: Reoperative surgery for chronic pancreatitis: is it safe?
abstract: BACKGROUND
  Eleven percent to fifty-six percent of patients do not achieve adequate pain relief with initial operative treatment for chronic pancreatitis, and reoperations for recurrent or persistent pain are common. This study evaluates the influence of prior pancreatic procedures on operative morbidity for chronic pancreatitis.
  
  
  METHODS
  The records of 336 consecutive patients who underwent pancreaticoduodenectomy (PD, n=78), lateral pancreaticojejunostomy (LPJ, n=152), distal pancreatectomy (DP, n=83), transduodenal sphincteroplasty (SP, n=20), and total pancreatectomy (TP, n=3) for chronic pancreatitis were retrospectively reviewed and analyzed.
  
  
  RESULTS
  Seventy-four patients underwent reoperation after failed prior pancreatic surgery. Patients with de novo pancreatic operations had a similar complication rate as those with reoperation (PD: 48% versus 65%, P>0.05; LPJ: 23% versus 23%, P>0.05; DP: 26% versus 28%, P>0.05; SP: 21% versus 100%, P>0.05). Major complications such as pancreatic leak or abdominal abscess were similar in the two groups. Minor complications such as delayed gastric emptying or wound infections were more common in the reoperation group. There was no difference in postoperative hospital length of stay.
  
  
  CONCLUSIONS
  Patients who undergo reoperative surgery for chronic pancreatitis have an increased risk for minor perioperative complications. The overall complication rate and the incidence of major complications are similar compared to de novo procedure. Reoperative surgery therefore appears feasible and safe in experienced hands.
authors.affiliation: Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina 29425, USA. schnelld@musc.edu
authors.forename: Thomas
authors.initials: T
authors.lastname: Schnelldorfer
authors.forename: David N
authors.initials: DN
authors.lastname: Lewin
authors.forename: David B
authors.initials: DB
authors.lastname: Adams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D016879:Salvage Therapy; D016896:Treatment Outcome