Conversion from bladder to enteric drainage for complications after pancreas transplantation.
OBJECTIVE
Bladder drainage (BD) of exocrine secretions is associated with urological and pancreatitis complications. Herein we have analyzed our experience with conversion from BD to enteric drainage (ED).


METHODS
From March 1995 to September 2008, 118 patients underwent pancreas transplantation. There were 68 men and 50 women of a overall mean age at transplantation of 37.8 years. There were 66 patients with bladder drainage (BD) and 52 with enteric drainage (ED).


RESULTS
Eight of 66 BD pancreas recipients (12.1%) underwent ED conversion. The mean time from pancreas transplantation to ED conversion was 29.3 +/- 30.6 months (range, 1-91 months). The major indications for conversion were recurrent reflux pancreatitis and chronic urinary tract infections in 7 patients; metabolic acidosis in 8; urethritis with severe perineoscrotal swelling in 1; and duodenocystostomy leak in 1. A comparative analysis of converted ED and not converted BD showed only a significantly prolonged period in the intensive care unit for patients who needed ED conversion (89 vs 47 hours; P < .01). Only 1 patient showed a duodenoenteric leak and peritonitis after conversion that required removal of the pancreas graft. The remaining 7 patients did not develop any postoperative complications and are currently well, showing normal pancreas graft function at a mean follow-up of 51.7 months after ED conversion. Patient and graft survivals were 100% and 87.5%, respectively. After ED conversion all urological complications disappeared; patients discontinued the use of oral bicarbonate.


CONCLUSIONS
ED conversion in pancreas transplant recipients with urological and reflux pancreatitis complications was a safe, effective procedure.
Jiménez-Romero
C
C
Servicio di Cirugía General, Hospital Doce de Octubre, Madrid, Spain. carlos.jimenez@inforboe.es
Manrique
A
A
Morales
J M
JM
López
R M
RM
Morales
E
E
Cambra
F
F
Calvo
J
J
García-Sesma
A
A
Praga
M
M
Moreno
E
E
D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods* / Q000502:physiology; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*