The role of pancreatic leakage on rising of postoperative complications following pancreatic surgery.
BACKGROUND
The variations in methods of pancreatic stump management and the volume of literature available on both main pancreatic duct and pancreaticoenetric anastomosis leak indicates the concern associated with the leak and the continuing efforts to prevent it. Herein we analyzed the role of pancreatic leakage followed by pancreatic surgery on the incidence of postoperative morbidity.


METHODS
From 1989 to 2005, we performed 76 pancreaticoduodenectomy (PD) and 26 distal pancreatectomy (DP), assumed as control case). During DP the parenchymal transection was performed with a linear stapler. The surgical reconstruction after PD was as follows: 11 manual nonabsorbable stitch closure of the main duct, 24 closure of the main duct with linear stapler, 17 temporary occlusion of the main duct with neoprene glue, and 24 duct-to-mucosa anastomosis.


RESULTS
In the PD group, morbidity rate was 60%, caused by pancreatic leakage, with an incidence of 48%, hemorrhagic complication, occurred in 10% of patients following surgical procedure and infectious complication, with an incidence of 15%. After distal pancreatectomy we recorded 80, 7% no complications, 3, 9% leakage, 15, 4% hemoperitoneum. By multivariate analysis bleeding complications, biliary anastomosis leakage, and infectious complications were consequences of pancreatic leakage (P = 0.025, P = 0.025, and P = 0.025, respectively). A significant statistical difference was recorded analyzing re-operation rates between closure of the main duct with linear stapler versus temporary occlusion of the main duct with neoprene glue (t = 0.049) and closure of the main duct with linear stapler versus duct-to-mucosa anastomosis (t = 0.003).


CONCLUSIONS
On the ground of our results of bleeding complication, biliary anastomosis leakage and infectious complication were consequences of pancreatic leakage: failure of a surgical anastomosis has serious consequences, particularly in case of anastomosis of the pancreas to the small bowel, because of the digestive capacities of activated pancreatic secretions.
Benzoni
Enrico
E
Department of Surgery, University of Udine, School of Medicine, Udine, Italy. enricobenzoni@gmail.com
Saccomano
Enrico
E
Zompicchiatti
Aron
A
Lorenzin
Dario
D
Baccarani
Umberto
U
Adani
Gian Luigi
GL
Uzzau
Alessandro
A
Noce
Luigi
L
Cedolini
Carla
C
Bresadola
Fabrizio
F
De Anna
Dino
D
Intini
Sergio
S
D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000601:surgery*; D003536:Cystadenocarcinoma / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*