Completion Pancreatectomy for Postoperative Peritonitis After Pancreaticoduodenectomy: Early and Late Outcome | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
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Original Article
January 1, 2004

Completion Pancreatectomy for Postoperative Peritonitis After Pancreaticoduodenectomy: Early and Late Outcome

Author Affiliations

From the Departments of Digestive Surgery (Drs Gueroult, Y. Parc, Paye, and R. Parc) and Endocrinology (Dr Duron), H[[ocirc]]pital Saint-Antoine, Assistance Publique/H[[ocirc]]pitaux de Paris, Universit[[eacute]] Pierre et Marie Curie, Paris, France.

Arch Surg. 2004;139(1):16-19. doi:10.1001/archsurg.139.1.16
Abstract

Hypothesis  Completion pancreatectomy in patients with pancreatic leakage associated with postoperative peritonitis after pancreaticoduodenectomy is a viable salvage procedure.

Design  Retrospective analysis from a cohort of consecutive patients admitted between January 1, 1989, and December 31, 1999, for postoperative peritonitis originating from pancreaticojejunostomy leakage.

Setting  Tertiary referral center with surgical intensive care unit specializing in the treatment of intra-abdominal sepsis.

Patients  Eight consecutive patients with postoperative peritonitis originating from pancreaticojejunostomy after pancreaticoduodenectomy, with a mean Acute Physiology and Chronic Health Evaluation II score of 18.6. We excluded patients with pancreatic fistulas or abscesses amenable to percutaneous drainage or other conservative treatment.

Intervention  Completion pancreatectomy.

Main Outcome Measures  Mortality, morbidity, and long-term outcome, which was assessed by interview.

Results  Three patients died in the postoperative period: 2 required early reoperation during the postoperative period and died of hemorrhage and sepsis, and 1 died of multiorgan failure without reoperation. Recurrence of carcinoma was responsible for late death of 2 other patients.

Conclusions  Posotperative peritonitis after pancreaticoduodenectomy still has high mortality; however, completion pancreatectomy may represent the only means to achieve source control of infection in cases of postoperative peritonitis.

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