Emergency Kausch-Whipple procedure: indications and experiences.
OBJECTIVE
Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure.


METHODS
Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications.


RESULTS
Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications.


CONCLUSIONS
Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.
Standop
Jens
J
Department of Surgery, University of Bonn Medical Center, Bonn, Germany. standop@uni-bonn.de
Glowka
Tim
T
Schmitz
Volker
V
Schaefer
Nico
N
Hirner
Andreas
A
Kalff
Jörg C
JC
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D012086:Reoperation; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome