gms | German Medical Science

Introduction: The aim was to investigate the effect of peripancreatic vascular disorders on the outcome on surgical therapy of chronic pancreatitis.

Material and methods: We performed a retrospective analysis of 324 patients with chronic pancreatitis who underwent surgery between 1999 and 2009. The outcome of 108 patients with vascular disorders was compared to 216 patients without vascular findings for peri- and postoperative parameters. Patients were divided into groups related to following vascular disorders: splenic vein thrombosis (SVT), vascular compression (VCO), left-sided portal hypertension (LPH), portal vein thrombosis (PVT), generalized portal hypertension (GPH) and arterial stenosis (AST).

Results: 34% of the 324 patients showed vascular disorders. Angiography and MRI proved to have the highest sensitivity in detecting vascular involvement. All analysed vascular findings lead to a significant higher perioperative rate of blood transfusion with a significant higher amount of transfused blood volume and prolonged operation time. No increase of postoperative pancreatic fistula (POPF), post pancreatectomy hemorrhage (PPH) or delayed gastric emptying (DGE) was found in patients with vascular disorders. Furthermore no effect was detected on hospital stay, re-operation rate or overall mortality. Beger’s procedure was identified as the surgical approach with the lowest perioperative risk profile in patients with vascular disorders.

Conclusion: Surgical therapy in patients suffering from chronic pancreatitis with vascular involvement is save but bears higher risk for perioperative blood loss and increased operation time. A broad preoperative stratification of vascular involvement via MRI seems crucial to identify patients at risk. Where possible Beger’s procedure seems to be a save option for patients suffering from chronic pancreatitis complicated by vascular alterations.