2005 Abstracts: Distal Pancreatectomy for Chronic Pancreatitis: Risk Factors for Increased Postoperative Drainage
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Distal Pancreatectomy for Chronic Pancreatitis: Risk Factors for Increased Postoperative Drainage
Thomas Schnelldorfer, David N. Lewin, David B. Adams, Medical University of South Carolina, Charleston, SC
Introduction: One of the most common complications after distal pancreatectomy is leakage from the pancreatic remnant. Factors influencing the development of pancreatic leaks after distal pancreatectomy have not been clearly elucidated.
Methods: The records of 79 patients who underwent distal pancreatectomy for chronic pancreatitis between 1995 and 2002 were retrospectively reviewed and analyzed. Operative specimen were reevaluated and microscopically classified according to the degree of fibrosis. The extent and distribution of fibrosis was graded from 1 to 12 utilizing a previously established scoring system. The daily output from surgical drains located at the pancreatic resection site was evaluated and compared to clinical features. Results: The complication rate after distal pancreatectomy was 29% with a pancreatic leak rate of 5%. Morbidity was not affected by the amount of postsurgical drainage. Drain output directly correlated with operative estimated blood loss (p<0.005) and operative time (p<0.001). Technique of pancreatic transsection and presence of suture closure of the pancreatic duct did not affect drain output. The average fibrosis score within the pancreatic specimen was 9±2.9. There was a reverse correlation between the degree of fibrosis and the amount of drainage (p<0.01) including perilobular (p<0.004) as well as intralobular fibrosis (p<0.004). 41% of patients had evidence of right sided pancreatic duct obstruction, determined by stricture or duct dilation within the head. Ductal obstruction within the pancreatic remnant did not correlate with output from surgical drains. Sinistral portal hypertension was present in 18% of patients. The weight of splenectomy specimen correlated with postsurgical drainage (p<0.02), whereas presence of gastric varices did not. Hospital length of stay was prolonged when high drainage was present (p<0.02) independent of perioperative morbidity. Conclusion: The amount of postsurgical drainage after distal pancreatectomy for chronic pancreatitis is dependent on the consistency of the pancreatic gland determined by its degree of fibrosis. Ductal obstruction in the remnant and surgical technique do not impact drainage. Drainage from surrounding tissue was influenced by the extent of operative trauma. Simultaneous splenectomy in the presence of splenomegaly also influenced the amount of drainage.
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