Journal of Gastrointestinal Surgery

, Volume 15, Issue 1, pp 191–198

Contemporary Single-Center Surgical Experiences in Redo Procedures of the Pancreas: Improved Outcome and Reduction of Operative Risk

  • Sabine Kersting
  • Monika Silvia Janot
  • Ansgar Michael Chromik
  • Dominique Suelberg
  • Waldemar Uhl
  • Matthias Hartmut Seelig
Original Article



Redo procedures of the pancreas are complex operations associated with significant morbidity and mortality rates. The operative risk may be minimised when indications for redo procedure are well reflected and operation is performed by an experienced surgeon. The aim of this study was to confirm this hypothesis evaluating our experiences with redo procedures.


We reviewed 28 patients (mean age of 54 years; range 11–75 years) undergoing a redo procedure of the pancreas from January 2004 to June 2008 at our hospital. The term redo procedure was defined as a pancreatic reoperation that was carried out after preceding pancreatic surgery. Relaparotomies following acute complications after pancreatic surgery were not taken into consideration.


The following parameters were evaluated: median operative time 332 min (range 160–730 min), median intraoperative blood loss 625 ml (range 300–2,800 ml), median postoperative stay on Intensive Care Unit 20 h (range 0–112 h), median postoperative hospital stay 15 days (range 7–98), morbidity (14%), and mortality (3.6%).


Redo procedures of the pancreas can be performed with low complication rates. In order to achieve a satisfactory outcome, the indication of redo procedures has to be well reflected, and operation may be performed by specialised and experienced surgeons.


Pancreatic surgery Redo procedure Chronic pancreatitis Operative risk Outcome 


  1. 1.
    Schnelldorfer T, Lewin DN, Adams DB. Reoperative surgery for chronic pancreatitis: is it safe? World J Surg 2006;30(7):1321–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Sohn TA, Lillemoe KD, Cameron JL, Pitt HA, Huang JJ, Hruban RH, Yeo C. Reexploration for periampullary carcinoma: resectability, perioperative results, pathology, and long-term outcome. Ann Surg 1999;229(3):393–400.PubMedCrossRefGoogle Scholar
  3. 3.
    Tyler DS, Evans DB. Reoperative pancreaticoduodenectomy. Ann Surg 1994;219(2):211–21.PubMedCrossRefGoogle Scholar
  4. 4.
    McGuire GE, Pitt HA, Lillemoe KD, Niederhuber JE, Yeo CJ, Cameron JL. Reoperative surgery for periampullary adenocarcinoma. Arch Surg 1991;126(10):1205–10; discussion 1210–2.PubMedGoogle Scholar
  5. 5.
    Shukla PJ, Qureshi SS, Shrikhande SV, Jagannath P, Desouza LJ. Reoperative pancreaticoduodenectomy for periampullary carcinoma. ANZ J Surg 2005;75(7):520–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Kleeff J, Reiser C, Hinz U, Bachmann J, Debus J, Jaeger D, Friess H, Buchler MW. Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 2007;245(4):566–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Adams DB, Ford MC, Anderson MC. Outcome after lateral pancreaticojejunostomy for chronic pancreatitis. Ann Surg 1994;219(5):481–7; discussion 487–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg 2002;236(5):612–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Russell RC, Theis BA. Pancreatoduodenectomy in the treatment of chronic pancreatitis. World J Surg 2003;27(11):1203–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Markowitz JS, Rattner DW, Warshaw AL. Failure of symptomatic relief after pancreaticojejunal decompression for chronic pancreatitis. Strategies for salvage. Arch Surg 1994;129(4):374–9; discussion 379–80.Google Scholar
  11. 11.
    Prinz RA, Aranha GV, Greenlee HB. Redrainage of the pancreatic duct in chronic pancreatitis. Am J Surg 1986;151(1):150–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD. Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg 1994;220(2):109–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Clavien PA, Sanabria JR, Mentha G, Borst F, Buhler L, Roche B, Cywes R, Tibshirani R, Rohner A, Strasberg SM. Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors. Ann Surg 1992;216(6):618–26.PubMedCrossRefGoogle Scholar
  14. 14.
    Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111(5):518–26.PubMedGoogle Scholar
  15. 15.
    Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001;120(3):682–707.PubMedCrossRefGoogle Scholar
  16. 16.
    Koninger J, Friess H, Muller M, Wirtz M, Martignioni M, Buchler MW. Duodenum-preserving pancreas head resection-an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg 2004;75(8):781–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Schnelldorfer T, Lewin DN, Adams DB. Operative management of chronic pancreatitis: long term results in 372 patients. J Am Coll Surg 2007;204(5):1039–45; discussion 1045–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Imrie CW. Management of recurrent pain following previous surgery for chronic pancreatitis. World J Sur 1990;14(1):88–93.CrossRefGoogle Scholar
  19. 19.
    Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301(25):1364–9.PubMedCrossRefGoogle Scholar
  20. 20.
    van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005;242(6):781–8, discussion 788–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349(22):2117–27.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Sabine Kersting
    • 1
  • Monika Silvia Janot
    • 1
  • Ansgar Michael Chromik
    • 1
  • Dominique Suelberg
    • 1
  • Waldemar Uhl
    • 1
  • Matthias Hartmut Seelig
    • 1
  1. 1.Department of General Surgery, St. Josef-HospitalRuhr University BochumBochumGermany

Personalised recommendations