Risk factors for complications after pancreatic head resection

Adam, Ulrich; Makowiec, Frank; Riediger, Hartwig; Schareck, W.; Benz, Stefan; Hopt, Ulrich T.

doi:10.1016/j.amjsurg.2003.11.004

Cited by 156 publications

(109 citation statements)

References 31 publications

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“…Tani et al (12) defined male gender, prolonged surgery, and blood transfusion as independent risk factors. Some studies report that parameters such as prolonged hospital stay, ERCP and stenting, the presence of preoperative jaundice, trauma/resection of the splenic vessels, additional surgical procedures, older age, the presence of intraabdominal infection, and nutritional risk index are factors that increase the risk of hemorrhage (2,(7)(8)(9)(12)(13)(14). Most of the factors mentioned above are present in our series (Table 1).…”

Section: Discussionmentioning

confidence: 73%

Postoperative hemorrhage complications after the Whipple procedure

Dılek

Özşay²,

Acar³

et al. 2018

Turk J Surg

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Introduction:The Whipple operation is an essential surgical technique; however, its high morbidity (30% to 60%) and mortality (5%) rates are problems that should be addressed. The incidence of postoperative hemorrhage is 5% to 16% in the literature. In this study, the data and results in our clinic regarding postoperative hemorrhage complications were evaluated. Material and Methods:The files of 185 patients who underwent the Whipple operation in our hospital in the last five years were evaluated retrospectively, and we attempted to determine the causes of hemorrhage. It was found that 13 (7%) patients experienced hemorrhage, and six of them were found to have died. In six of these cases, hemorrhage occurred due to fistulas from the portal vein, gastroduodenal artery, and pancreatic arteries at variable periods. Two cases were found to have developed disseminated intravascular coagulation as a result of sepsis. Early intervention was performed in two cases who bled from the meso veins and in one case who bled from the portal vein. Laparotomy and hemostasis were performed on a patient who bled from the gastric anastomosis line. In a patient who had been taking low molecular weight heparin, bleeding from the drains and nasogastric tube stopped following cessation of the drug.Discussion: Preventive procedures such as connection of the vascular structures, use of vascular sealants, omental patching during surgery, and reducing the risk of complications by using somatostatin analogs were performed to prevent hemorrhages after Whipple surgeries. Results:In addition to known methods, angiography and embolization are emerging as effective methods in the diagnosis and treatment of hemorrhages. Furthermore, the determination and elimination of independent risk factors, such as jaundice, that affect fistula formation and bleeding in the perioperative period is important for prevention Keywords: Complication, hemorrhage, pancreas, treatment, Whipple operation INTRODUCTIONThe Whipple operation is an essential surgical technique for periampullary tumors; however, its high morbidity (30% to 60%) and mortality (5%) rates are problems that should be addressed (1-3). Pancreatic fistulas (2% to 62%) are among the most common complications after the Whipple procedure (1, 4). The incidence of postoperative hemorrhage is 5% to 20.2% in the literature. Mortality due to hemorrhage is reported as 15% to 58% (1, 5-7). Hemorrhages may arise from the suture lines in the early period; here, we evaluate the data and results from our clinic regarding postoperative hemorrhage problems in cases who developed infections and fistula in the days following surgery. MATERIAL AND METHODSThe files of 185 patients who underwent the Whipple operation in our hospital in the last five years (2011 to 2015) were evaluated retrospectively; we also attempted to determine the causes of hemorrhage. As a routine procedure, all patients signed consent forms containing information about the routine procedures and complications. Cases who had hemorrhoids, anal fiss...

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Section: Discussionmentioning

confidence: 73%

Postoperative hemorrhage complications after the Whipple procedure

Dılek

Özşay²,

Acar³

et al. 2018

Turk J Surg

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“…PD nowadays represents a complex procedure and a challenge for the surgeon. Recently, the operative mortality rate after PD has significantly declined, while the incidence of postoperative morbidity remains high, from 40%-50% [1][2][3][4][5][6], and a recent series of 650 operations demonstrated a 30-day mortality of 1.4% [7]. The improved mortality is related to improve general management surgeon expertise and higher volume of procedures being performed in a hospital [5].…”

Section: Introductionmentioning

confidence: 99%

Analysis of procedure-related complications after pancreatodoudenectomy

et al. 2010

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Purpose To analyze the procedure-related complications after pancreaticoduodenctomy (PD) and their risk factors.Methods One hundred twenty-six patients underwent pancreatoduodenectomy for diseases at region of pancreatic head were reviewed retrospectively. ResultsThe overall surgical morbidity was 40.5% (51/126). Ten (7.9%) of 51 patients were identified as having pancreatic leakage, others included delayed gastric emptying (8.7%, 11), abdominal infection and abscess (7.9%, 10), abdominal bleeding (5.6%, 7), wound infection (4.8%, 6), wound dehiscence (2.4%, 3), biliary fistula (1.6%, 2) and operative death (1.6%, 2). Other postoperative complications were lung inflammation (3.9%, 5) and newly developed diabetes mellitus (2.3%, 3). Age (>60 years), coexisting diabetes mellitus, small main pancreatic duct (≤0.5 cm), and surgeon's experience (<10 patients within 5 years) were demonstrated to be independent risk factors by both univariate and multivariate analysis (p < 0.01).Conclusions Old patients with coexisting diabetes mellitus and small main pancreatic duct undergo pancreatoduodenectomy by a less experienced surgeon may be at high risk of procedure-related complications.

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“…In particular, pancreatic fistula is one of the most severe postoperative complications after pancreatic surgery. Pancreatic fistula is reportedly associated with a higher incidence of life-threatening complications, such as intraabdominal abscess, intra-abdominal hemorrhage, and sepsis (8)(9)(10)(11)(12). A strategy to decrease pancreatic fistula after pancreatic surgery is urgently required.…”

Section: Introductionmentioning

confidence: 99%

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

Kitahata¹,

Kawai²,

Yamaue³

2016

Transl. Gastroenterol. Hepatol.

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Pancreatic fistula is one of severe postoperative complications that occur after pancreatic surgery, such as pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). Because pancreatic fistula is associated with a higher incidence of life-threatening complications. In order to evaluate procedure or postoperative management to reduce pancreatic fistula after pancreatic surgery, we summarized some randomized controlled trials (RCTs) regarding pancreaticoenterostomy during PD, pancreatic duct stent during PD, procedure to resect pancreatic parenchyma during DP, and somatostatin and somatostatin analogues after pancreatic surgery.At first, we reviewed nine RCTs to compare pancreaticogastrostomy (PG) with pancreaticojejunostomy (PJ) during PD. Next, we reviewed five RCTs, to evaluate the impact of pancreatic duct stent during PD. Regarding DP, we reviewed six RCTs to evaluate appropriate procedure to reduce pancreatic fistula after DP. Finally, we reviewed eight RCTs to evaluate the impact of somatostatin and somatostatin analogues after pancreatic surgery to reduce pancreatic fistula. The best way to prevent pancreatic fistula after pancreatic surgery remains still controversial. However, several RCTs clarify a useful procedure to reduce in reducing the incidence of pancreatic fistula after pancreatic surgery. Further RCTs to study innovative approaches remain a high priority for pancreatic surgeons to prevent pancreatic fistula after pancreatic surgery.

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Risk factors for complications after pancreatic head resection

Cited by 156 publications

References 31 publications

Postoperative hemorrhage complications after the Whipple procedure

Postoperative hemorrhage complications after the Whipple procedure

Analysis of procedure-related complications after pancreatodoudenectomy

Clinical trials to reduce pancreatic fistula after pancreatic surgery—review of randomized controlled trials

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