[Redo procedures in patients with pancreatic left resection].
BACKGROUND
Distal pancreatectomy is performed less frequently than pancreatic head resection. Secondary operations due to postoperative complications are surgically complex and demanding, hence often interdisciplinary approaches are pursued. We have analysed the indications and outcome of revision surgery and interventional procedures subsequent to pancreatic left resection.


METHODS
Between 2001 and 2009 we prospectively evaluated 61 patients regarding demographic factors, hospital stay, diagnosis, closure technique, redo operations and interventions, morbidity and mortality.


RESULTS
Major complications without redo procedures were observed in 4 (9 %) of 44 patients. 8 (13 %) patients underwent early (7 +/- 8 days) postoperative revision procedures. A significant in-crease in hospital stay and mortality appeared in this group. Interventional procedures (7 x CT-guided abscess drains, 1 x haemorrhage with angio-graphic coiling, 1 x transgastral stenting of a pseudocyst) were performed significantly later (22 +/- 11 days p. o., p < 0,01) in 9 (15 %) patients.


CONCLUSIONS
Pancreatic fistulas and related complications represent the most common indications for revisions, but can usually be controlled by interventional procedures. In contrast to secondary surgery, interventional revisions do not significantly increase the length of hospital stay or mortality. There was no benefit of any certain closure technique of the pancreatic remnant.
Glowka
T R
TR
Universitätsklinikum Bonn, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Bonn, Deutschland.
Webler
M
M
Hirner
A
A
Kalff
J C
JC
Standop
J
J
D018784:Abdominal Abscess / Q000401:mortality / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004322:Drainage; D004621:Embolization, Therapeutic; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005773:Gastroscopy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000401:mortality / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000601:surgery*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D015607:Stents; D025321:Surgery, Computer-Assisted; D015996:Survival Rate; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D015718:Fibrin Tissue Adhesive