Surgical versus nonsurgical management of traumatic major pancreatic duct transection: institutional experience and review of the literature.

OBJECTIVE: The objective of this study was to review the literature, report our experience, and compare operative versus nonoperative management of patients with major pancreatic duct transection (MPDT) from blunt trauma.

METHODS: We compare the outcome of 39 patients reported in the literature who had surgical management (S group) with 12 patients who were conservatively managed with combined expectant and image-guided percutaneous procedures (NS group). We also review the surgical and nonsurgical management of 7 patients with MPDT treated in the past 12 years at our center (Louisiana Series [LS] group).

RESULTS: Age at time of injury and complication and fistula formation rates were not significantly different between the 2 groups. Total parental nutrition was administered in 10.3% of patients in the S group and 66.7% in the NS group (P = 0.0003). The NS group required longer hospitalization compared with the S group (P = 0.005). The LS group length of stay was significantly shorter than that of the NS group (P = 0.04). Although some centers kept their patient with nonsurgical management as inpatient until the drain was removed, LS patients were discharged home with the drain.

CONCLUSIONS: Both operative and nonoperative approaches for management of MPDT from blunt trauma can be entertained successfully with similar complication rates. The management of these patients should be individualized based on their clinical condition.