Improved Outcomes with Limited Pancreatic Head Resections for Benign Disease
Abstracts
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The Duodenum-Preserving Pancreatic Head Resection (DPPHR) by Beger, and the Extended Lateral Pancreatico-Jejunostomy (ELPJ) by Frey, have expanded the surgical treatment of benign pancreatic disease. Improved outcomes and lower morbidity compared to the Whipple (WHIP) procedure have been reported, but direct comparisons of DPPHR and ELPJ have been limited. We reviewed our single-surgeon experience with these resections, compared to standard and pylorus-sparing WHIP resection, distal pancreatic resections (DPR) and pancreatic duct sphincteroplasties (PDS) performed contemporaneously. From 3/97 to 9/01, a total of 86 pancreatic procedures were performed, including 12 DPPHR, 12 ELPJ, 30 WHIP, 16 DPR, and 5 PDS. We evaluated indications, including chronic pancreatitis (CP), benign tumors (BT), and malignancies (CA); morbidity, including operative time (OT), blood loss (BL), length of nasogastric intubation (NG), length of post-op stay (LS), and major complications (MC); and outcomes, including new or worsened diabetes (DM), persistent analgesic use (PA), and complete functional recovery (FR). Results show low morbidity and similar outcomes with DPPHR and ELPJ (Table 1, data expressed as means). Two perioperative deaths occured after WHIP. Major complications included pancreatic duct leaks in 3 DPPHR, 2 WHIP and 1 DPR, portal vein occlusion, right hepatic lobe necrosis and reexploration for bleeding in 1 WHIP each; intraabdominal fluid collection in 3 WHIP and 1 ELPJ, and small bowel obstruction in 1 ELPJ. Persistent analgesic use and failures to achieve full functional recovery were similar in DPPHR, ELPJ and WHIP groups. New or worsened diabetes occurred after 4 WHIP operation, 1 DPPHR, 1 ELPJ and 1 DPR. Improvement of diabetes was seen after 1 DPPHR and 1 ELPJ. Our initial experience suggests low morbidity and good outcomes with both DPPHR and ELPJ. The early functional recovery and freedom from analgesics are similar. The morbidity of DPPHR is similar to the WHIP procedure, although length of stay and mortality are comparable to lesser procedures. Long term follow up will be required to determine whether patients with benign disease benefit preferentially from DPPHR vs. ELPJ, but both appear to offer better outcomes than WHIP. |
