Article
Management of postoperative complications after hepato-pancreato-biliary surgery (HPB) – a proof of concept study
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Authors
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Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Annemarie Weißenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Matthias Zitt
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
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Robert Öllinger
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Center of Operative Medicine, Innsbruck
| Published: | April 26, 2013 |
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Outline
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Introduction: Complications after HPB surgery are life-threatening conditions eventually requiring reoperations. In this study a concept of immediate placement of sufficient 2-canal drains in the anastomotic region after liver- and pancreas-resection was analyzed retrospectively in order to decrease the rate of relaparotomies.
Material and methods: 158 consecutive patients after hepato-pancreato-biliary (major pancreas- and liver-resection) surgery were included in the study. Postoperatively bilirubin and lipase-levels were measured daily in the effluent from intraoperatively placed drainages. Ultrasonography was routinely performed in order to identify early intraabdominal fluid retention. CT/MR-scans were performed, if mentioned diagnostics were inconclusive or patients´ condition deteriorated. If 3 days postoperatively bilirubin/lipase-levels in the effluent did not display serum-levels a pancreatic/biliary fistula was assumed. Depending on maximal values of bilirubin/lipase a continuous infusion of 10-160ml/h 0.9% saline-chloride was performed until drain bilirubin/lipase-levels dropped to normal serum-values. If these measures failed, either endoscopic-retrograde-cholangiopancreatography (ERCP) with/without papillotomy and/or stent-implantation or relaparotomy were carried out.
Results: Out of the 158 patients fistulas of either origin occurred in 21 cases (13.2%). The primary therapeutic approach consisted in continuous infusion with saline via the intraoperatively or postoperatively, radiologically (in 4 patients) placed drainages. In 14 patients (66.7%) secretion suspended and required no further intervention. ERCP with papillotomy was necessary in 2 patients (9.52%), and placement of a stent in 1 patient (4.76%) with a biliary leakage, in order to achieve optimal bile duct effluent and occlusion of the fistula. Conservative and interventional approach failed in 4 patients (19,0%), in which relaparotomy and oversewing of the leaking bile duct was necessary. No patients with pancreatic fistulas after major pancreas surgery required surgical reintervention.
Conclusion: Diagnosed fistulas could be successfully treated conservatively in the majority of the cases and the rate of relaparotomies for fistulas reduced to 2.5%. In conclusion an intraoperatively placed drainage can optimize postoperative care after major HPB surgery.
