title: Postoperative complications linked to pancreaticoduodenectomy. An analysis of pancreatic stump management.
abstract: OBJECTIVE
  To analyze the role of different procedures in the management of pancreatic stump according to the incidence of postoperative morbidity derived from the data of a single center surgical population.
  
  
  METHODS
  From 1989 to 2005 we performed 76 pancreaticoduodenectomies (PD) and 26 distal pancreatectomies (DP). The surgical reconstruction after PD was as follows: 11 manual non-absorbable stitches closure of the main duct, 24 closures of the main duct with linear stapler, 17 occlusions of the main duct with neoprene glue and 24 duct-to-mucosa anastomosis.
  
  
  RESULTS
  In the PD group, the morbidity rate was 60%, caused by: pancreatic leakage in 48% of patients, hemorrhagic complications in 10% following surgical procedure and infectious complications in 15%. After DP we recorded: leakage in 3.9%, haemoperitoneum in 15.4% and no complications in 80.7%. The multivariate analysis showed that the in-hospital mortality was linked to the surgical procedure (PD, p=0.003) and to the following complications: pancreatic leakage (p=0.004), haemoperitoneum (p=0.00045) and infectious complications (p=0.0077). Bleeding complications, biliary anastomosis leakage and infectious complications were consequences of pancreatic leakage (p=0.025, p=0.025 and p=0.025 respectively).
  
  
  CONCLUSIONS
  Manual non-absorbable stitch closure of the main duct and occlusion of the main duct with neoprene glue should be avoided in the reconstructive phase.
authors.affiliation: Department of Surgery, University of Udine, School of Medicine, P.le S. Maria della Misericordia, 33100 Udine, Italy. enricobenzoni@yahoo.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Benzoni
authors.forename: Aron
authors.initials: A
authors.lastname: Zompicchiatti
authors.forename: Enrico
authors.initials: E
authors.lastname: Saccomano
authors.forename: Dario
authors.initials: D
authors.lastname: Lorenzin
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Adani
authors.forename: Luigi
authors.initials: L
authors.lastname: Noce
authors.forename: Alessandro
authors.initials: A
authors.lastname: Uzzau
authors.forename: Carla
authors.initials: C
authors.lastname: Cedolini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bresadola
authors.forename: Sergio
authors.initials: S
authors.lastname: Intini
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques