[Our efforts to decrease surgical complications following pancreatic resections].

INTRODUCTION

The most frequent surgical complications following pancreatic resections are pancreatic fistula and delayed gastric emptying. The aim of the authors was to analyse these complications in their own practice.

MATERIAL AND

METHODS

Clinical data of 287 patients were reviewed, who were radically operated on for malignant pancreatic or periampullary tumours during 14 years period. The most common neoplasm was pancreatic adenocarcinoma, located in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy was most frequently performed. In the early period pancreatogastrostomy and double-layer pancreatojejunostomy were preferred during the reconstruction, as well as retrocolic duodeno-, and gastrojejunostomy, respectively. Later the authors turned to the single-layer implantation pancreatojejunostomy and to the antecolic reconstruction, the latter was completed with Braun anastomosis.

RESULTS

In the postoperative course complications occurred in 39%, reoperation was done in 5.6%, and the early mortality rate was 3.8%. The rate of pancreatic fistula decreased to 5.9% following single-layer pancreatojejunostomy, and the difference was significant compared to the 17.6% rate after pancreatogastrostomy. Due to the antecolic reconstruction the frequency of delayed gastric emptying has reduced from 10.2% to 2.1%, which is a statistically significant difference.

CONCLUSIONS

As a result of changes in the surgical techniques during the 14 years period, the frequency of pancreatic fistula and delayed gastic emptying has dramatically decreased, which underlines the need of continuous progress in surgical methods.