Upfront Distal Pancreatectomy vs. Upfront Non-Operative Management in Pediatric Grade III Pancreatic Trauma: a single institution review.

INTRODUCTION

Management of grade III blunt pancreatic injury has shifted towards non-operative management (NOM) in pediatric trauma. In adults, the standard of care remains distal pancreatectomy (DP). We hypothesized that upfront DP in pediatric grade III pancreatic injury would be associated with faster post-injury recovery, compared to upfront NOM.

METHODS

We retrospectively reviewed minors presenting to a level 1 pediatric trauma center with AAST grade III blunt pancreatic injury from 2015-2025. Bivariate analyses compared baseline characteristics, management strategies and outcomes between upfront DP (<72 hours from injury) and upfront NOM (no DP within 72 hours of injury) strategies. Regression analyses evaluated independent predictors of time to full oral diet intake.

RESULTS

31 patients met inclusion criteria (n=12 DP, n=19 NOM). The baseline characteristics of each cohort were similar. There were non-significant trends towards lower readmissions (NOM: 0 [0-1], DP: 0 [0-0]), total hospital length of stay (days, NOM: 10 [7-29], DP: 9 [6-16]), time to full oral diet intake (days, NOM: 28 [4-37], DP: 8 [4-13]) and discharge on home supplemental nutrition (NOM: 47%, DP:17%) in the DP group. There were no differences in rates of post-traumatic diabetes mellitus or exocrine pancreatic insufficiency between groups, with limited follow up (NOM: 37d [18-90], DP: 41d [20-257]). Upfront distal pancreatectomy was independently associated with earlier time to full oral diet on regression analysis.

CONCLUSIONS

Our hypothesis-generating findings suggest that in pediatric grade III blunt pancreatic injuries, upfront distal pancreatectomy may be associated with faster post-injury recovery, though statistical significance was not reached.