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World Journal of Surgery

, Volume 39, Issue 6, pp 1550–1556 | Cite as

Salvage Completion Pancreatectomies as Damage Control for Post-pancreatic Surgery Complications: A Single-Center Retrospective Analysis

  • Michael F. Nentwich
  • Alexander T. El GammalEmail author
  • Torben Lemcke
  • Tarik Ghadban
  • Eugen Bellon
  • Nathaniel Melling
  • Kai Bachmann
  • Matthias Reeh
  • Faik G. Uzunoglu
  • Jakob R. Izbicki
  • Maximilian Bockhorn
Original Scientific Report

Abstract

Background

Post-pancreatic surgical morbidity is frequent but often manageable by less invasive means than re-operation. Yet, some complications can become hazardous and life threatening. Herein, the results of a completion pancreatectomy (CP) to cope with severe post-operative pancreatic fistulas (POPF) and bleeding complications after major pancreatic resections for suspected pancreatic malignancy are presented.

Methods

CPs to treat severe post-pancreatic index-surgery complications between January 2002 and January 2012 were selected out of a prospective database. Indications for CP as well as perioperative data were prospectively collected and retrospectively assessed.

Results

In 20 of 521 Kausch–Whipple Resections (3.8 %), a CP was necessary to treat post-index surgery morbidity. Indications included insufficiency of the pancreaticojejunal anastomosis with resulting POPF in 14 (70.0 %) patients, severe bleeding complications in 6 (30.0 %) patients, and a severe portal vein thrombosis in 1 (5.0 %) patient. In 7 (35.0 %) of the 20 patients, the course was complicated by remnant pancreatitis. Eleven (55.0 %) of the 20 patients died during the hospital stay. Median time to re-operation did not significantly differ between survivors and in-hospital deaths (10.0 vs. 8.0 days; p = 0.732). Median hospital stay of the surviving patients was 31.0 (range 10–113) days. Re-operations following CPs were necessary in 5 (55.6 %) of the 9 patients who survived and in 9 (81.8 %) out of 11 patients who died.

Conclusions

Post-pancreatic resection complications can become hazardous and result in severely ill patients requiring maximum therapy. CP in these cases has a high mortality but serves as an ultima ratio to cope with deleterious complications.

Keywords

Pancreatic Fistula Pancreatic Resection Pancreatic Remnant Pancreatic Anastomosis Anastomotic Insufficiency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors deny any potential or real conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Michael F. Nentwich
    • 1
  • Alexander T. El Gammal
    • 1
    Email author
  • Torben Lemcke
    • 1
  • Tarik Ghadban
    • 1
  • Eugen Bellon
    • 1
  • Nathaniel Melling
    • 1
  • Kai Bachmann
    • 1
  • Matthias Reeh
    • 1
  • Faik G. Uzunoglu
    • 1
  • Jakob R. Izbicki
    • 1
  • Maximilian Bockhorn
    • 1
  1. 1.Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany

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