Redo Surgery After Duodenum-Preserving Pancreatic Head Resection for Chronic Pancreatitis: High Incidence in Long-Term Follow-up

J Gastrointest Surg. 2015 Jun;19(6):1078-85. doi: 10.1007/s11605-015-2791-6. Epub 2015 Apr 23.

Abstract

Introduction: Duodenum-preserving pancreatic head resection is a safe procedure with a more favorable short-term outcome compared to pancreaticoduodenectomy. However, some patients develop mechanical complications or suspicion of malignancy during follow-up and need reoperation years after primary surgery. Aim of this study was to evaluate incidence, techniques, and complication rates of redo operations.

Materials and methods: We reviewed short- and long-term outcomes of 33 patients who underwent duodenum-preserving pancreatic head resection for chronic pancreatitis from 1997 to 2010 at our department from a prospective database.

Results: Short-term outcome after duodenum-preserving pancreatic head resection was comparable with previous data. Follow-up (mean 89 months) was achieved for 26 patients. Eight patients (30.1 %) needed a redo operation of which seven were performed. Indications were obstructive jaundice (four patients) and suspicion of cancer of pancreatic head (four patients; carcinoma confirmed in three patients). Mean interval between initial and redo operation was seven years for benign stenoses and 4 years for cancer. Three of seven operated patients needed revision.

Conclusion: Need for redo operations after duodenum-preserving pancreatic head resection is high and these operations have high complication rates. In most cases, redo operations can be avoided by performing pancreaticoduodenectomy as initial operation.

MeSH terms

  • Adult
  • Aged
  • Denmark / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pancreatectomy / methods*
  • Pancreaticoduodenectomy / methods*
  • Pancreatitis, Chronic / surgery*
  • Postoperative Complications / epidemiology*
  • Prospective Studies
  • Reoperation
  • Time Factors