Surgical Management and Outcomes of Combined Pancreaticoduodenal Injuries: Analysis of 75 Consecutive Cases

Kotze, U.; Setshedi, Mashiko; Nicol, Andrew; Navsaria, Pradeep

doi:10.1016/j.jamcollsurg.2016.02.005

Cited by 40 publications

(47 citation statements)

References 38 publications

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“…The accurate intra-operative assessment of major pancreatic injuries may be complex and the surgeon may be faced with a range of uncertainties, some of which only become apparent during the procedure[16,17,22]. When major blood loss and shock occur, strategies including rapid haemostasis and damage control intervention become imperative, necessitating deferred resection and/or reconstruction at a more opportune time when abnormal physiological parameters have been restored[17,26].…”

Section: Discussionmentioning

confidence: 99%

“…When major blood loss and shock occur, strategies including rapid haemostasis and damage control intervention become imperative, necessitating deferred resection and/or reconstruction at a more opportune time when abnormal physiological parameters have been restored[17,26]. After resection, technical difficulties may arise in the reconstruction of the pancreatic and biliary anastomoses due to a mismatch in size with non-dilated biliary and pancreatic ducts, often aggravated by gross edema of the jejunum and small bowel mesentery and soft pancreatic parenchyma[12,16].…”

Section: Discussionmentioning

confidence: 99%

“…Although pancreas-specific complications were surprisingly low after PD, the overall complication rate in this category of resection was high. This emphasizes the need for combined and integrated involvement of both trauma and HPB surgeons familiar with the full spectrum and exigencies of pancreatic trauma[17]. …”

Section: Discussionmentioning

confidence: 99%

“…Details of the methodology used to record the variables for each patient have previously been published[12-17]. A comprehensive data set of complications and related key variables were recorded.…”

Section: Methodsmentioning

confidence: 99%

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Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

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AIMTo benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.METHODSA prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.RESULTSOverall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant.CONCLUSIONThis ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

Self Cite

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“…liver, splenic, renal and/or vascular injury). Penetrating trauma (gunshot, stab wound) appears to be the main cause of pancreatic trauma in the United States and South Africa (15,16,17), while in the rest of the world pancreatic trauma is mainly blunt and related to road traffic accidents (up to 54 -85%), sport injuries and falls (4,18). Blunt abdominal trauma by bicycle handle bar is responsible for every third-second paediatric pancreatic trauma (19,20).…”

Section: Mechanism Of Pancreatic Injury Mechanism Of Pancreatic Injurymentioning

confidence: 99%

Diagnosis and Management of Blunt Pancreatic Trauma

Kollár

Molnár

Zsoldos

et al. 2018

SGO

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Introduction: Blunt or penetrating pancreatic trauma represents only 0.2-2% of all trauma cases and approximately 3-12% of all abdominal injuries. While treatment protocol debates of other intra-abdominal and thoracic organ injuries seem to reach comforting conclusions, satisfying evidence-based recommendations regarding the pancreas have not been released yet. However, high grade trauma of the pancreas can lead to substantial morbidity and mortality. The question is, when and how to treat it conservatively or operatively. Objectives/Methods: This study is a review of contemporary literature on children and adult pancreatic trauma management strategies and findings. The purpose is to evaluate current classifications and the efficacy of subsequent non-operative and operative treatments. We list the established grading systems starting from physical examination, imaging diagnosis, to indications for surgery or conservative management, followed by post-treatment morbidity and mortality rates. Conclusions: Current operative or non-operative management strategies are not based on randomized -or even, in fact, on prospective -clinical trials. Most of the available publications demonstrate small retrospective patient cohorts and expert opinions. To date, no convincing high level (at least Level III) evidence-based recommendations have been published in terms of treatment of these injuries. There is a general agreement, that the injury of the main pancreatic duct is the thin red line, dividing conservative and operative strategies. Low grade pancreatic injury can be treated conservatively not significantly different from protocols developed for mild pancreatitis of other origin. Pancreatic duct damage in adults requires either minimal invasive intervention or exploration and reconstruction/resection via laparotomy. Treatment strategies of high grade paediatric pancreatic injuries remain controversial. Associated organ injuries can mask the symptoms of pancreatic trauma. Missed main pancreatic duct injuries pose a clinically challenging situation with serious complications and considerable mortality. Pancreatic injury in polytrauma poses the highest risk. Present perspectives for survival of pancreatic injury as mono trauma varies between 95-100%, while as a part of polytrauma, the mortality rate is as high as 30-35%. Multicentre prospective, randomized clinical trials would be ideal to support optimal decision making. Heterogeneity of cases and relative rarity of the pathology makes the creation of such a database highly unlikely.Pancreatic injury makes up a relatively small proportion of trauma cases: the pancreas is affected in 0.2-2% of all trauma patients and in 2-12% of all

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What Is the Optimal Management of Traumatic Duodenal Injury?

Kent

Bendix

2021

Difficult Decisions in Trauma Surgery

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Surgical Management and Outcomes of Combined Pancreaticoduodenal Injuries: Analysis of 75 Consecutive Cases

Cited by 40 publications

References 38 publications

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Diagnosis and Management of Blunt Pancreatic Trauma

What Is the Optimal Management of Traumatic Duodenal Injury?

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