title: Operative intervention for complete pancreatic transection in children sustaining blunt abdominal trauma: revisiting an organ salvage technique.
abstract: Complete pancreatic transection (CPT) in children is managed commonly with distal pancreatectomy (DP). Alternatively, Roux-en-Y distal pancreaticojejunostomy (RYPJ) may be performed to preserve pancreatic tissue. The purpose of this study was to review our experience using either procedure in the management of children sustaining CPT after blunt abdominal trauma. We retrospectively reviewed the records of all children admitted to our institution during the last 15 years who were confirmed at operation to have CPT after blunt mechanisms. Summary statistics of demographic data were performed to describe children receiving either RYPJ or DP. CPT occurred in 28 children: 15 had DP, 10 had RYPJ, and three had cystogastrostomy. RYPJ children, compared with DP, were younger (7.5 vs. 12.3 years, P = 0.039) and sustained more grade IV pancreatic injuries (70% vs. 14%, P = 0.01). DP patients were 5.63 times more likely to tolerate full enteral feeds (P = 0.009). Nevertheless, when controlling for age, injury severity score, and pancreatic injury grade, procedure type did not statistically affect total and postoperative lengths of stay and postoperative complications. In the operative management algorithm of children sustaining CPT, DP may afford an earlier return to full enteral feeds. RYPJ seems otherwise equivalent to DP and preserves significant pancreatic glandular tissue and the spleen.
authors.affiliation: Department of Pediatric Surgery, Vanderbilt Medical Center, Nashville, Tennessee 37232-2730, USA. matthew.j.borkon@vanderbilt.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Borkon
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Morrow
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Koehler
authors.forename: Yu
authors.initials: Y
authors.lastname: Shyr
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Hilmes
authors.forename: Richard S
authors.initials: RS
authors.lastname: Miller
authors.forename: Wallace W
authors.initials: WW
authors.lastname: Neblett
authors.forename: Harold N
authors.initials: HN
authors.lastname: Lovvorn
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010179:Pancreas / Q000293:injuries / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*