ABSTRACT
Background: Pancreatic surgeries have undergone substantial changes over the last few decades and are now being attempted by many surgeons not limited to specialised centres. The study has attempted to document the indications for elective pancreatic surgeries and its outcomes in terms of morbidity and mortality.Methods: This observational study included 42 patients over a period of 12 months. The data were recorded in a predesigned proforma to assess the indication for elective pancreatic surgery, to describe the number and kind of pancreatic operation undertaken and to evaluate the short-term outcome of various pancreatic surgeries in terms of complications, morbidity and mortality.Results: Authors studied 42 patients, who underwent the elective pancreatic surgeries for various indications in hospital. Histopathological studies revealed that the majority (50%) were carcinoma of the head of pancreas. Pancreaticoduodenectomy (PD) was done in all the sixteen cases. The most important complications of PD were delayed gastric emptying (DGE) (50%), surgical site infection (SSI) (43.7%), post pancreatic haemorrhage (PPH) (31%), post-operative pancreatic fistula (POPF) (25%) and intra-abdominal abscess (IAA) (12.5%). Of the 26 patients operated for benign conditions of pancreas, 19 (73%) had pancreatic pseudocyst, in majority of cases as a sequela of alcohol induced pancreatitis. Partington Rochelle procedure was the commonest surgical procedure in chronic pancreatitis.Conclusions: Carcinoma of head of pancreas was the most common periampullary malignancy necessitating major pancreatic resections. DGE, POPF and PPH were the most common and significant post-operative complications.
ABSTRACT
Background: There is no gold standard method for pancreatico-enteric reconstruction. In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice. In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out of 75 (6.6%) developed Grade ‘B’ POPF and three out of 75 (3.3%) developed Grade ‘C’ POPF. 20 out of 75 (26.6%) had grade ‘A’ DGE, five out of 75 (6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (Invagiantion) pancreatojejunostomy has accepatable early outcomes with clinically significant/relevant postoperative pancreatic fistula rates of Grade B (6.6%) and Grade C (4%), delayed gastric emptying (33.2%) and post pancreatic hemorrhage (5.3%) rates. The outcomes are comparable with Duct-to-mucosa PJ mentioned in literature.