[Evaluation of conditioning factors of morbimortality in duodenopacreatectomy in periampullary neoplasms].
OBJECTIVE
The purpose of this study is to define the factors that condition complications and mortality in a group of 119 patients with periampullary neoplasms operated on at a general hospital.


METHODS
Between October 2002 and December 2006, 119 patients who were diagnosed with periampullary neoplasms and underwent a pancreatoduodenectomy at Rebagliati Hospital were evaluated.


RESULTS
Age and sex were not conditioning factors of complications. A significant difference in the type of pancreatic anastomosis used was noticed, whereby telescoping was a conditioning factor of complication (p<0.009) compared with mucous-mucous anastomosis.After analyzing the bleeding associated with each complication, a significant connection was established between the greatest bleeding volume obtained in the operating room with the development of pancreatic fistulas (p<0.03), re-operation (p<0.01), abscesses (p<0.006) and intestinal fistulas (p<0.001).The complications related to mortality in patients who underwent a pancreatoduodenectomy (PD) were evaluated. It was observed that pancreatic fistulas (p<0.003), intestinal fistulas (p<0.003) and gallbladder fistulas (p<0.03), intra-abdominal hemorrhaging and bleeding during a standard operating procedure (SOP), transfusions and re-operations were factors that increased mortality significantly. When the surgeon was evaluated as a factor of morbimortality, it was proven that there was a connection between the surgical volume and the incidence of complications and mortality.There was a shorter hospital stay, a lower incidence of intra-operative bleeding and lower morbimortality in the high surgical volume group.


CONCLUSIONS
The most-feared complications, since they are directly related to mortality, are intestinal fistulas, intra-abdominal hemorrhaging, intra-abdominal abscesses, gallbladder fistulas and the need to undergo repeated operations. Both complications and mortality are directly related to the surgeon factor, which, according to our analysis is the most important factor in decreasing costs, morbidity and mortality in this type of surgery.
Targarona
Javier
J
Médico del servicio 6 B Cirugía de Páncreas, Hospital Edgardo Rebagliati Martins, Lima-Perú. jtargaronam@viabc.com
Pando
Elizabeth
E
Vavoulis
Alexandra
A
Sequeiros
Joel
J
Garatea
Rafael
R
Rotta
Cesar
C
Barreda
Luis
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications