|
Back to 2015 Annual Meeting Program
Pancreaticojejunostomy Stricture After Pancreatoduodenectomy: Outcomes After Operative Revision
Jessica Cioffi*, Lucas a. Mcduffie, Alexandra M. Roch, Nicholas J. Zyromski, Eugene P. Ceppa, C. Max Schmidt, Attila Nakeeb, Michael G. House
Surgery, Indiana University, Indianapolis, IN
Introduction: The natural history of radiographic strictures of the pancreaticojejunostomy (PJ) after pancreatoduodendectomy (PD) is difficult to characterize. The limited long-term survival after PD for pancreatic cancer and the ductal abnormalities of the remnant gland after PD for chronic pancreatitis hinder prospective studies of PJ strictures. The purpose of this study was to identify the indications for operative revision of PJ strictures after PD for benign and malignant disease and to evaluate its safety and clinical efficacy.
Methods: A retrospective review of all patients undergoing operative revision of PJ strictures following PD at a single academic institution over an 8 year period was performed (2006-2014).
Results: Among 1,175 patients who underwent PD during the study period, 27 (2.2%) were selected for revision of a radiographically (33% CT, 56% MRCP) detectable PJ stricture associated clinically with recurrent acute pancreatitis and upper abdominal pain. Within the PJ revision group, 26% had undergone PD for cancer, 19% for chronic pancreatitis, and 35% for benign periampullary tumors. Post-PD pancreatic fistula (PF) and/or intra-abdominal abscess had occurred in 30% of patients. The median time from PD to PJ stricture revision was 55 mos (range 3.5-270 mos). Median pancreatic duct diameter was 5.2 mm (range, 2-9 mm) at the time of PJ revision and correlated closely with pre-operative imaging estimation (6.2 mm). The median increase in the main pancreatic duct diameter between the time of PD and PJ revision was 2 mm (range 0-5 mm) with an initial pancreatic duct range of 1-6 mm. PJ revision was achieved with a two-layer duct-to-mucosa anastomosis in 24 (89%) patients and lateral pancreaticojejunostomy in 3 (11 %). Average operative time was 232 min (range 98-412 min) with estimated blood loss of 299 mL (range 25-3000 mL). Thirty-three percent of patients required operative revision of a hepaticojejunostomy stricture and 15% required revision of a gastrojejunostomy or duodenojejunostomy stricture at the time of PJ revision. The overall morbidity after PJ revision was 26% (4% PF) with a median hospital LOS of 6 days (range 3-21 days). No postoperative mortality occurred. Twenty-one (78%) patients experienced complete resolution of symptoms without recurrent acute pancreatitis after PJ revision during a median follow-up of 30 mos (range 2.5-96 mos) with durable symptom resolution reported among 60% of patients with chronic pancreatitis.
Conclusions: Surgical revision of PJ strictures is technically safe and clinically effective for selected patients who experience recurrent acute pancreatitis after PD for either benign or malignant disease.
Back to 2015 Annual Meeting Program
|
