Postoperative Complications Linked to Pancreaticoduodenectomy. An Analysis of Pancreatic Stump Management

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Enrico Benzoni, Aron Zompicchiatti, Enrico Saccomano, Dario Lorenzin, Umberto Baccarani, Gianluigi Adani, Luigi Noce, Alessandro Uzzau, Carla Cedolini, Fabrizio Bresadola, Sergio Intini

Department of Surgery, University of Udine, School of Medicine, Udine, Italy


Aims. To analyze the role of different procedures in the management of pancreatic stump according to the incidence of postoperative morbidity derived from the data of a single center surgical population.

Methods. From 1989 to 2005 we performed 76 pancreaticoduodenectomies (PD) and 26 distal pancreatectomies (DP). The surgical reconstruction after PD was as follows: 11 manual non-absorbable stitches closure of the main duct, 24 closures of the main duct with linear stapler, 17 occlusions of the main duct with neoprene glue and 24 duct-to-mucosa anastomosis.

Results. In the PD group, the morbidity rate was 60%, caused by: pancreatic leakage in 48% of patients, hemorrhagic complications in 10% following surgical procedure and infectious complications in 15%. After DP we recorded: leakage in 3.9%, haemoperitoneum in 15.4% and no complications in 80.7%. The multivariate analysis showed that the in-hospital mortality was linked to the surgical procedure (PD, p=0.003) and to the following complications: pancreatic leakage (p=0.004), haemoperitoneum (p=0.00045) and infectious complications (p=0.0077). Bleeding complications, biliary anastomosis leakage and infectious complications were consequences of pancreatic leakage (p=0.025, p=0.025 and p=0.025 respectively).

Conclusion. Manual non-absorbable stitch closure of the main duct and occlusion of the main duct with neoprene glue should be avoided in the reconstructive phase.

Key words
Pancreaticoduodenectomy - postoperative complication - anastomotic leak - Whipple's procedure