Abstracts
2000 Digestive Disease Week

# 2315 Re-Admissions After Pylorus Preserving Pancreatoduodenectomy.
Rutger C. I. Geenen, Laurens Th. Wit, Thomas M. Gulik, Huug Obertop, Dirk J. Gouma, Amsterdam, Netherlands

Morbidity and mortality after pylorus preserving pancreatoduodenectomy (PPPD) have been extensively analyzed previously but little is known about the long-term complications and re-admissions. These complications severely affect the quality of life of patients after PPPD. The aim of the study is to analyze indication, treatment and outcome of the re-admissions of patients after PPPD. From October 1992 till June 1999, 283 PPPDs were performed (malignant disease: 243, benign disease: 40). The hospital mortality was 3/283 (1%). Re-admissions after PPPD for recurrence or for complications of the primary surgery were analyzed with regard to treatment, hospital stay, interval between the PPPD and the first re-admission and hospital-free survival. Of the 280 patients 108 patients (39%) were re-admitted (173 re-admissions). Most of the patients were re-admitted with recurrent disease (61%). Important indications were gastrointestinal obstruction (13), biliary obstruction (14) and pain (21). Treatment consisted of gastroenterostomy (7), exploration (2), biliary bypass (5), laxation/rehydration and analgestics (6), drainage (13), and conservative treatment. Thirty-one (47%) patients with recurrent disease were re-admitted for endstage palliation (survival after re-admission < 1 month). 47 (44%) of the patients were readmitted for surgical complications as abscess (10), gastrointestinal obstruction (7), fistula (7), incisional hernia (4), anastomotic ulcer (4), pancreatitis (4), and hemorrhage (3) and general discomfort (10). Median hospital stay for re-admissions after PPPD was 10 days (recurrent disease: 12 days, surgical related complications: 7 days). The median interval between the PPPD and the first re-admission was 5 months. The median hospital-free survival for patients with a re-admission after the initial surgical procedure was 16 months (recurrent disease: 13 months, surgical related complications: 30 months). After surgical intervention for recurrent disease median survival was 8 weeks. In conclusion, after pancreatoduodenectomy 39% of the patients are re-admitted. Sixty-one percent of these patients are re-admitted for recurrent disease, of which 47% are re-admitted for end-stage palliation. Forty-four percent of the patients that are re-admitted, are re-admitted for surgical related complications, with good prognosis.