Article

Emergency Kausch-Whipple procedure: indications and experiences.

Department of Surgery, University of Bonn Medical Center, Bonn, Germany.
Pancreas (impact factor: 2.39). 03/2010; 39(2):156-9. DOI:10.1097/MPA.0b013e3181bb98d2 pp.156-9
Source: PubMed

ABSTRACT Pancreaticoduodenectomy is a demanding procedure even in selected patients but becomes formidable when performed in cases of emergency. This study analyzed our experience with urgent pancreatoduodenectomies; special emphases were put on the evaluation of diagnostic means and the validation of existing indications for performance of this procedure.
Three hundred one patients who underwent pancreatoduodenectomy between 1989 and 2008 were identified from a pancreatic resection database and reviewed for emergency indications.
Six patients (2%) underwent emergency pancreatoduodenectomy. Indications included endoscopy-related perforation, postoperative complications, and uncontrollable intraduodenal tumor bleeding. Length of stay and occurrence of nonsurgical complications were increased in emergency compared with elective pancreatoduodenectomies. Although increased, no significant differences were found regarding mortality and surgery-related complications.
Indications for emergency pancreatoduodenectomies were based on clinical decisions rather than on radiologic diagnostics. Urgent pancreatic head resections may be considered as an option in selected patients if handling of local complications by interventional measures or limited surgery seems unsafe.

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Keywords

cases
 
clinical decisions
 
demanding procedure
 
diagnostic
 
elective pancreatoduodenectomies
 
emergency pancreatoduodenectomies
 
emergency pancreatoduodenectomy
 
endoscopy-related perforation
 
interventional measures
 
limited surgery
 
local complications
 
nonsurgical complications
 
postoperative complications
 
radiologic diagnostics
 
special emphases
 
study analyzed
 
surgery-related complications
 
uncontrollable intraduodenal tumor
 
Urgent pancreatic head resections
 
urgent pancreatoduodenectomies
 

Jens Standop