Trauma pancreaticoduodenectomy for complex pancreaticoduodenal injury. Delayed reconstruction.
OBJECTIVE
To assess the feasibility and safety of the delayed reconstruction approach in patients with complex pancreaticoduodenal injuries.


METHODS
Tertiary care center in Northern India.


METHODS
Five patients with complex pancreaticoduodenal injuries, three following blunt and two following penetrating injury.


RESULTS
All patients underwent a pancreaticoduodenectomy. T-tube drainage of the common bile duct and external tube drainage of the pancreatic duct were established. A wide bore tube drain was left in the right upper abdomen. The postoperative course was uneventful in four patients. One patient died from coagulopathy on the 4th postoperative day. Delayed reconstruction was carried out in four patients. In one patient, a pancreaticojejunal anastomosis could not be performed. The postoperative period was uneventful and no patient had a biliary or a pancreatic leak. All four patients are well on follow-up.


CONCLUSIONS
Delayed reconstruction in complex pancreaticoduodenal injuries is a feasible and viable option as was demonstrated by this study. Controlled external tube drainage of the bile and pancreatic ducts facilitates postoperative care and prevents on-going contamination of the peritoneal cavity with bile and pancreatic juice. Leaving behind the uncinate process shortens the operating time with less blood loss. Planned reconstruction is carried out once the inflammatory process has settled.
Gupta
Vikas
V
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Wig
Jai Dev
JD
Garg
Harsh
H