title: Salvage pancreaticogastrostomy for pancreatic fistulae after pancreaticoduodenectomy.
abstract: Pancreatic anastomotic dehiscence after pancreaticoduodenectomy (PD) remains a common problem. Although the management of this condition is mostly conservative, some patients require surgical intervention. This study reviews our experience with surgical intervention in this clinical setting. All patients who underwent PD by the author between 1999 and 2011 were reviewed. The causes for reoperation and mortality after PD were evaluated. The nature of the operative intervention and outcome in those who underwent reoperation for postoperative pancreatic fistula were analyzed. Reoperation was necessary in a total of 36/208 patients in this series and the overall mortality for the entire series was 6.25 % (13/208). Twelve of these 36 reoperations in 208 patients were for treatment of pancreatic anastomotic dehiscence after PD. Five (42 %) patients reoperated for anastomotic dehiscence died, including four of six patients that underwent surgical drainage of percutaneously inaccessible collections and one of two patients that underwent completion pancreatectomy. None of those who underwent salvage pancreaticogastrostomy (PG) died, nor did they require additional interventions prior to discharge from hospital. In our experience, salvage PG was an effective and organ function preserving technique to manage pancreatic anastomotic dehiscence after PD.
authors.affiliation: Bangalore Institute of Oncology Specialty Centre, HCG Towers, #8 P. Kalinga Rao Road, Sampangiram Nagar, Bangalore, 560 027, India. s4govil@gmail.com
authors.forename: Sanjay
authors.initials: S
authors.lastname: Govil
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome