Emergency Kausch-Whipple Procedure

Department of Surgery, University of Bonn Medical Center, Bonn, Germany.
Pancreas (Impact Factor: 2.96). 03/2010; 39(2):156-9. DOI: 10.1097/MPA.0b013e3181bb98d2
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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    • "Bleeding from such papillae is usually quite massive and the condition of patients changes dynamically. Spontaneous bleeding from the duodenum that requires performance of pancreatectomy is described by Standop and co-authors [10]. The procedure is similar and equally urgent. "
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Jens Standop