title: A pancreas-preserving technique for the management of symptomatic pancreatic anastomotic insufficiency refractory to conservative treatment after pancreas head resection.
abstract: OBJECTIVE
  Management of symptomatic pancreatic anastomotic insufficiency after pancreas head resection remains controversial. Completion pancreatectomy as one frequently performed option is associated with poor prognosis.
  
  
  METHODS
  During a 4-year period, a two-step strategy was applied in four consecutive patients suffering from pancreatic anastomotic insufficiency refractory to conservative management after a pancreas head resection. In the first step, sepsis was overbridged by meticulous debridement and resection of the pancreaticojejunostomy, leaving the biliary anastomosis untouched, and selective drainage of the pancreatic duct as well as the peripancreatic area. In the second step, after recovery, the procedure was completed with a novel pancreaticojejunostomy.
  
  
  RESULTS
  The surgical procedure was completed in three patients after a mean of 164 (range: 112-213) days. One patient died from cardiac arrest 54 days after the reoperation with resolved abdominal sepsis. No pancreatic anastomotic insufficiency occurred after the new pancreaticojejunostomy had been performed. Three patients are alive and tumor-free with normal exocrine and endocrine pancreatic function after a mean follow-up of 20.3 (3-38) months following the definitive reconstruction.
  
  
  CONCLUSIONS
  The two-step pancreas-preserving strategy can be used as an alternative to completion pancreatectomy for patients suffering from severe pancreatic anastomotic insufficiency.
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Königsrainer
authors.forename: Derek
authors.initials: D
authors.lastname: Zieker
authors.forename: Stefan
authors.initials: S
authors.lastname: Beckert
authors.forename: Jörg
authors.initials: J
authors.lastname: Glatzle
authors.forename: Torsten H
authors.initials: TH
authors.lastname: Schroeder
authors.forename: Alexandra
authors.initials: A
authors.lastname: Heininger
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000601:surgery*; D003646:Debridement; D004322:Drainage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation; D016896:Treatment Outcome