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    Ahmad Gamal1, Haitham A. Eldmarany1, Ahmed Farghaly1, Ahmed Elmarakby1, Ayman Refaat2.
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    Hany M S Mikhail MD, FRCS, Hany A. Balamoun MD, FRCS
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    Abd Elrahman Elmaraghy, Mahmoud Saad Farahat and Mohammed abdo MD
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    • Study of reoperation after Pancreatico-duodenectomy

    Abd Elrahman Elmaraghy, Mahmoud Saad Farahat and Mohammed abdo MD
    Department of General Surgery, Ain Shams University

    Background: reoperation after pancreatico-duodenectomy is a difficult decision but sometimes needed for treatment of complications after failure of other conservative measures. Aim: To identify the incidence, indications and results of surgery for patients undergoing reoperations for treatment of complications after pancreatico-duodenectomy. Methods: retrospective analysis of data records of patients undergoing pancreatico-duodenectomy from June 2011 to August 2016 was performed. Results: 46 patients underwent pancreatico-duodenectomy; 30 whipples, 10 underwent pylorus preserving pancreatico-duodenectomy and 6 underwent total pancreatectomy. 11 patients (24 %) were re-operated. All re-operated patients were done once except for 2 patients that had been re-operated twice. Timing for re-operation ranged from 1- 24 days after pancreatico-duodenectomy. Indications for re-operation were post pancreatectomy hemorrhage in 3 patients (27.3 %), persistent pancreatico-jejunal anastomotic leak in 6 (54.5%), hepatico-jejunostomy leak in 3 (27.3%), leakage from gastro-jejunal and duodeno-jejunal anastomosis in 2 (18%) and peritonitis which is not amenable for U/S guided drainage in 6 (54.5%). Mortality was higher in the reoperated group (36.4%) compared to 1 (2.9%) in the other group. Operations done included drainage, refashioning of anastomosis and completion pancreatectomy and all were accompanied with feeding jejunostomy. Conclusion: re-operations following pancreaticoduodenectomy, although difficult decision and carries high risk of morbidity and mortality, it is sometimes mandatory to treat complications refractory to conservative measures. Completion pancreatectomy may have a role as a last surgical option in treatment of post pancreatectomy complications. high pre-operative total bilirubin > 10 mg%, Pancreatico-jejunal anastomotic (PJA) leak, Intraabdominal collections and Septicemia are all independent risk factors (predictors) for reoperation after pancreatectomy. Key words: pancreatico-duodenectomy, early complications, re-operations and completion pancreatectomy. 

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