gms | German Medical Science

Background: Pancreas resection is a common procedure for benign and malignant diseases of pancreas. Despite substantial reduction or mortality, postoperative morbidity remains high. Some of the complications require relaparotomies and even salvage pancreatectomy.

Our aim was to evaluate the rate, reasons, risk factors and outcome for relaparotomy after pancreas resections in our single center collective of 1100 patients.

Materials and methods: Between 2001 and 2014 pancreas resections were performed in 1100 patients at the Clinic of General and Visceral Surgery, University of Freiburg. Evaluation of postoperative complications was performed for pancreatoduodenectomy (PD), duodenum preserving pancreatic head resection (DPPHR) and distal pancreatectomy (DP) separately. Perioperative data was continuously collected in a SPSS database (SPSS, Version 22.0, SPSS Inc.,Chicago, IL, USA). Statistical significance was tested using the Man-Whitney-U-Test, Fischer´s exact test and Chi-square tests.

Results: 131 (11.9%) patients required relaparotomy due to complications after pancreas resections. 37 (3.4%) of these patients required multiple relaparotomies up to 10 times. Indications for relaparotomie included intraabdominal abscess (53; 4.8%), insufficiency of pancreatoenteric anastomosis (32; 2.9%), complications concerning the biliodigestive anastomosis 28 (2.5%), complications related to the gastrojejunostomy 11 (1 %), and burst abdomen 10 (0.9%).

Perioperative independent riskfactors for relaparotomie were intraoperative blood transfusion (P = 0.045), multi visceral resection (P = 0.045), preoperative endobiliary stent (P = 0.002) and pancreatogastrostomy (P = 0.025).

22 (2%) patients required salvage pancreatectomy, while after 2013 in 5 patients with pancreatojejunostomy the pancreatic remnant was preserved as pancreatogastrostomy. 12 patients died after relaparotomie (9.2%) compared to the overall mortality of 2.3%.

Conclusion: Abdominal infection and complications related to pancreatoenteric and bilioenteric anastomosis are the most frequent reasons of relaparotomy after pancreas resections. Exceptional expertise required to keep lethality in these patients low and avoid salvage pancreatectomies.