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Journal of Gastrointestinal Surgery

, Volume 13, Issue 8, pp 1503–1509 | Cite as

Operative Re-intervention Following Pancreatic Head Resection: Indications and Outcome

  • Jens StandopEmail author
  • Tim Glowka
  • Volker Schmitz
  • Nico Schäfer
  • Marcus Overhaus
  • Andreas Hirner
  • Jörg C. Kalff
Original Article

Abstract

Background

This study analyzed indication and outcome regarding operative re-intervention following pancreatoduodenectomy (PD) and pancreatogastrostomy (PG) with special emphasis on complications related to redo surgery.

Patients and Methods

Two hundred eighty-five patients who underwent PD with PG between 1989 and 2008 were identified from a pancreatic resection database and indications for repeat surgery were registered. Patients with and without reoperation were analyzed with regard to gender, age, underlying disease, length of hospital stay, mortality rate, and postoperative complications.

Results

Thirty-one patients (11%) underwent operative reintervention. Early intra-abdominal extraluminal postoperative bleeding was the main cause for redo surgery followed by abdominal abscesses. Thirteen percent of patients with and 1.9% without secondary surgery died during the postoperative course. Forty-five percent of reoperated patients had to undergo at least one more operation resulting in doubling of the length of hospital stay. There was no correlation between patients’ gender, age, and underlying disease and the need for operative reintervention. However, redo surgery was associated with higher incidence of delayed gastric emptying, pancreatic fistula and bleeding, and non-surgery related complication. Intra-abdominal bleeding and abscesses, insufficiencies of bilio-digestive and gut anastomosis, wound infections, and pancreatitis were observed significantly more often in patients with secondary surgery.

Conclusions

Complications after pancreatic resection that require operative re-intervention are associated with a notably increased mortality, ranging between 13% and 60%. Apart from the surgeon’s experience in selecting patients and his/her personal technical skills in performing a pancreaticoduodenectomy, timely anticipation and determined management of postoperative complications is essential for improving the outcome of this operation.

Keywords

Operative re-intervention Redo surgery Repeat laparotomy Additional operation Secondary surgery Kausch–Whipple procedure Partial pancreaticoduodenectomy Pancreatic resection 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Jens Standop
    • 1
    Email author
  • Tim Glowka
    • 1
  • Volker Schmitz
    • 2
  • Nico Schäfer
    • 1
  • Marcus Overhaus
    • 1
  • Andreas Hirner
    • 1
  • Jörg C. Kalff
    • 1
  1. 1.Department of SurgeryUniversity of Bonn Medical CenterBonnGermany
  2. 2.Department of GastroenterologyUniversity of Bonn Medical CenterBonnGermany

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