Surgical approach to pancreas injury: A 15 years experience
Alper Akcan, Hızır Akyıldız, Can Küçük, Namık Yılmaz, Engin Ok, Erdoğan Sözüer, Zeki Yılmaz
Erciyes Üniversitesi Tıp Fakültesi Genel Cerrahi AD, KAYSERİ
Purpose: Pancreatic injuries due to trauma are relatively rare. Because of retroperitoneal location of the pancreas, there are difficulties in diagnosis and treatment. Aim of this study is to analyze the treatment outcomes of patients undergoing surgery for pancreatic injuries in our center.
Materials and Methods: Between January 1990 and September 2006, medical records of 51 patients who underwent surgical intervention for pancreatic trauma were investigated. Age, sex, type of injury, diagnostic interventions, co-injuries of other organs, surgical approach, hospital stay time, morbidity and mortality rates were evaluated retrospectively.
Results: Eleven patients had blunt traumas, 26 stab wounds and 14 gunshot injuries. Co-injuries were seen in 42 patients. In 34 patients, serum amylase levels were initially high. Preoperative ultrasonographic examinations were performed in 47, and computerized tomography in 31 patients. In 19 out of 23 cases that had grade I injuries, external drainage was performed; and for the remaining four distal pancreatectomy and splenectomy were performed. Grade II injury was seen in 10 patients. Seven of them had spleen sparing distal pancreatectomy, and three had distal pancreatectomy and splenectomy. External drainage was performed in two out of nine grade III patients and distal pancreatectomy or subtotal pancreatectomy was performed in seven. There were six grade IV injuries. Three of them had subtotal pancreatectomy and the remaining three had pancreaticoduodenectomy. In all of the three grade V injuries, pancreaticoduodenectomy procedures were performed. Postoperative complication rate was 41.2%. Most frequent ones are athelectasis and pneumonia respectively which were seen in seven patients. Perioperative mortality rate was 13.7%.
Conclusion: The choice of surgical intervention in pancreatic injuries, depends on the status of pancreatic duct, parenchymal injury grade, co-injuries and anatomical localisation.
Keywords: Pancreatic injury, surgery, treatment