The role of interventional radiology in the management of surgical complications after pancreatoduodenectomy.

Department of Hepatopancreatobiliary Surgery, Ninewells Hospital, Dundee Medical School, Dundee, UK.
HPB (Impact Factor: 1.94). 12/2012; 14(12):812-7. DOI: 10.1111/j.1477-2574.2012.00545.x
Source: PubMed

ABSTRACT This study evaluates the role of interventional radiology (IR) in the management of postoperative complications after pancreatoduodenectomy (PD).
A total of 120 consecutive patients were reviewed to identify IR procedures performed for early complications after PD.
Findings showed that 24 patients (20.0%) required urgent radiological or surgical re-intervention for early complications, including 11 instances of post-pancreatectomy haemorrhage (PPH), six intra-abdominal abscesses, two bile leaks, one pancreatic fistula and one bowel ischaemia. Three of 24 complications were managed by surgery and 21 were managed by IR. Two of 11 PPHs involved intraluminal haemorrhage (ILH) and nine involved intra-abdominal haemorrhage (IAH). One ILH was managed conservatively and one required surgical intervention. In eight of nine patients with IAH, the bleeding site was identified on computed tomography angiography, and endovascular stenting or coil embolization were performed. No patient required a re-look laparotomy following IR for haemorrhage or intra-abdominal abscess. Overall, three of 120 patients required an urgent re-look laparotomy for early complications.
Rates of major morbidity after PD remain high. However, many significant complications (PPH, pancreatic fistula, intra-abdominal abscess) can be managed by IR, reducing the need for reoperation. Re-look surgery is still required in a small percentage (2.5%) of patients.

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