%0 Journal Article
%T Reoperation following Pancreaticoduodenectomy
%A J. R. Reddy
%A R. Saxena
%A R. K. Singh
%A B. Pottakkat
%A A. Prakash
%A A. Behari
%A A. K. Gupta
%A V. K. Kapoor
%J International Journal of Surgical Oncology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/218248
%X Introduction. The literature on reoperation following pancreaticoduodenectomy is sparse and does not address all concerns. Aim. To analyze the incidence, causes, and outcome of patients undergoing reoperations following pancreaticoduodenectomy. Methods. Retrospective analysis of 520 consecutive patients undergoing pancreaticoduodenectomy from May 1989 to September 2010. Results. 96 patients (18.5%) were reoperated; 72 were early, 18 were late, and 6 underwent both early and late reoperations. Indications for early reoperation were post pancreatectomy hemorrhage in 53 (68%), pancreatico-enteric anastomotic leak in 10 (13%), hepaticojejunostomy leak in 3 (3.8%), duodenojejunostomy leak in 4 (5%), intestinal obstruction in 1 (1.2%) and miscellaneous causes in 7 (9%). Patients reoperated early did not fare poorly on long-term follow up. Indications for late reoperations were complications of index surgery (n = 12), recurrence of the primary disease (n = 8), complications of adjuvant radiotherapy (n = 3), and gastrointestinal bleed (n = 1). The median survival of 16 patients reoperated late without recurrent disease was 49 months. Conclusion. Early reoperations following pancreaticoduodenectomy, commonly for post pancreatectomy hemorrhage, carries a high mortality due to associated sepsis, but has no impact on long-term survival. Long-term complications related to pancreaticoduodenectomy and adjuvant radiotherapy can be managed successfully with good results. 1. Introduction Descriptions of post pancreaticoduodenectomy (PD) reoperations have largely addressed relaparotomy for early complications such as postpancreatectomy hemorrhage (PPH) and pancreaticoenteric anastomotic leak (PEA) with associated intraabdominal collection [1, 2]. The literature on other indications is very limited. Quite a number of studies have addressed the long-term survival of patients undergoing PD and the need for readmission in them on long-term follow up [3, 4]. However, there is very limited data that specifically addresses the need for and the outcome of surgical reintervention in these patients on long-term follow up. The aim of this study was to analyze the following. (i) The incidence and causes of early and late reoperations following PD. (ii) Factors predicting the need for early reoperation and its related mortality. (iii) The outcome of patients undergoing early and late reoperations. 2. Patients and Methods Five hundred and twenty patients underwent PD between May 1989 and September 2010 at the Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute
%U http://www.hindawi.com/journals/ijso/2012/218248/