Salvage Completion Pancreatectomies as Damage Control for Post‐pancreatic Surgery Complications: A Single‐Center Retrospective Analysis

Abstract

Post-pancreatic resection complications can become hazardous and result in severely ill patients requiring maximum therapy. CP in these cases has a high mortality but serves as an ultima ratio to cope with deleterious complications.

Is there any differences in post-operative course among the three main types of periampullary tumour?

“…Many studies have reported the complications of pancreaticoduodenectomy and their risk factors. However, there has been no report of the differences in the incidence of complications after pancreaticoduodenectomy among the different types of periampullary tumour [11,12]. Pancreatic fistula is a frequent and important complication of post-pancreaticoduodenectomy, and also leads to multiple other morbidities, such as intra-abdominal abscess, postoperative bleeding, and delayed gastric emptying [13,14].…”

An Alternative Surgery for an Atypical Kind of Grade C Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy

“…Non-operative management can be initially attempted but, soon, concomitant bleeding, pancreatitis, peritonitis, sepsis, clinical deterioration up to hemodynamic instability affect nearly all patients making redo surgery imperative and the only salvage treatment (1)(2)(3)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). In this regard, so many surgical alternatives are available today that surgeons are often spoiled for choice; however, it is important to say that no procedure has met with unanimous consensus thus far (1)(2)(3)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Completion pancreatectomy has been long advocated as the operation of choice because it decreases the erosion exerted by pancreatic juice; however, its use has been progressively retrenched because of the demanding accomplishment, significant mortality rate (38-64%) and severe related consequences (both exocrine and endocrine pancreatic insufficiency, including a complex diabetic condition named "brittle" diabetes, with a mortality rate of 3.5%) (5-7).…”

“…Considering this knowledge, removal of the pancreas remnant in the context of a grade-C fistula can be considered an unnecessarily highrisk overtreatment" (12). However, although this and other succeeding papers surrounding this particular subject have described a profusion of surgical techniques, so far no one has been mentioning of including intestinal resection to the operative management of pancreatic stump (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Interestingly, this omission seems to be flanked with another important anatomopathologic aspect overlooked by nearly all authors: the condition of the Rough-limb anastomozed to the pancreas.…”

Pancreatico-enteric fistula post pancreatic duct ligation for delayed haemorrhage complicating pancreaticoduodenectomy

“…However complex life threatening complications may mandate a salvage procedure such as a completion pancreatectomy or external tube pancreatostomy. Salvage completion pancreatectomies are associated with high mortality rates [4] . Patients who undergo an external tube pancreatostomy in the acute setting may have a favorable mortality risk [5] .…”