Pancreatic redo procedures: to do or not to do -- this is the question.
BACKGROUND
Pancreatic redo procedures belong to the most difficult abdominal operations because of altered anatomy, significant adhesions, and the potential of recurrent disease. We report on our experience with 15 redo procedures among a series of 350 consecutive pancreatic operations.


METHODS
From January 1, 2004 to May 31, 2006 a total of 350 patients underwent pancreatic surgery in our department. There were 15 patients identified who had pancreatic redo surgery for benign (14) or malignant (1) disease. Perioperative parameters and outcome of 15 patients undergoing redo surgery after pancreatic resections were evaluated.


RESULTS
Operative procedures included revision and redo of the pancreaticojejunostomy after resection of the pancreatic margin (6), completion pancreatectomy (3), conversion from duodenum-preserving pancreatic head resection to pylorus-preserving pancreaticoduodenectomy (3), classic pancreaticoduodenectomy after nonresective pancreatic surgery (1), redo of left-sided pancreatectomy (1), and classic pancreaticoduodenectomy after left-sided pancreatectomy (1). Histology revealed chronic pancreatitis in 14 and a mucinous adenocarcinoma of the pancreas in 1 patient. Median operative time was 335 min (235-615 min) and median intraoperative blood loss was 600 ml (300-2,800 ml). Median postoperative ICU stay was 20 h (4-113 h) and median postoperative hospital stay was 15 days (7-30 days). There was no perioperative mortality and morbidity was 33%.


CONCLUSIONS
Pancreatic redo surgery can be performed with low morbidity and mortality. Redo surgery has a defined spectrum of indications, but to achieve good results surgery may be performed at high-volume centers.
Seelig
Matthias H
MH
Department of General Surgery, St Joseph Hospital, Ruhr-University Bochum, Gudrunstrasse 56, Bochum, Germany.
Chromik
Ansgar M
AM
Weyhe
Dirk
D
Müller
Christophe A
CA
Belyaev
Orlin
O
Mittelkötter
Ulrich
U
Tannapfel
Andrea
A
Uhl
Waldemar
W
D000328:Adult; D003251:Constriction, Pathologic; D003536:Cystadenocarcinoma / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D005763:Gastroenterostomy; D006801:Humans; D007583:Jejunum / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D050500:Pancreatitis, Chronic / Q000601:surgery*; D012086:Reoperation