title: Pancreatic redo procedures: to do or not to do -- this is the question.
abstract: 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.
authors.affiliation: Department of General Surgery, St Joseph Hospital, Ruhr-University Bochum, Gudrunstrasse 56, Bochum, Germany.
authors.forename: Matthias H
authors.initials: MH
authors.lastname: Seelig
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Chromik
authors.forename: Dirk
authors.initials: D
authors.lastname: Weyhe
authors.forename: Christophe A
authors.initials: CA
authors.lastname: Müller
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mittelkötter
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
mesh_terms: 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