Role of interventional radiology in the management of complications after pancreaticoduodenectomy

• Published in: The American journal of surgery Vol. 195; no. 3; pp. 386 - 390
• Main Authors: Baker, Todd A., M.D, Aaron, Joshua M., M.D, Borge, Marc, M.D, Pierce, Kenneth, M.D, Shoup, Margo, M.D., F.A.C.S, Aranha, Gerard V., M.D., F.R.C.S. (C), F.A.C.S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2008; Elsevier Limited
• Subjects: Abdomen; Adult; Aged; Aged, 80 and over; Antibiotics; Bile leak; Complication; Female; Hospitalization; Hospitals; Humans; Interventional radiology; Intra-abdominal abscess; Male; Medical imaging; Middle Aged; Morbidity; Mortality; Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticoduodenectomy - adverse effects; Patients; Percutaneous; Postoperative Complications - diagnostic imaging; Postoperative Complications - therapy; Radiography, Interventional; Reoperation; Retrospective Studies; Stents; Surgery; Bile leak; Percutaneous; Interventional radiology; Intra-abdominal abscess; Complication; Pancreaticoduodenectomy; Pancreatic fistula
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.12.026

Abstract Background This study evaluated the role of interventional radiology (IR) procedures to manage complications after pancreaticoduodenectomy. Methods A retrospective review was made of the records of patients with postsurgical complications managed with IR. Results Among the 440 patients reviewed, the mortality, morbidity and reoperation rates were 1.6%, 36%, and 2%, respectively. Complications occurred in 159 patients, of which 39 (25%) required ≥1 IR procedures. Of those 39 patients, 72% underwent percutaneous drainage of an intra-abdominal abscess, 18% underwent percutaneous biliary drainage, and 10% underwent angiography for gastrointestinal bleeding or pseudoaneurysm. The reoperation rate among the 159 patients with complications was 6% (n = 9). Reoperation was avoided in 90% of patients receiving IR. Four patients underwent reoperation despite IR for persistent abscess, pancreatic fistula, anastomotic disruption, or mesenteric venous bleeding. Conclusions The majority of complications occurring after pancreaticoduodenectomy can be managed effectively using IR, thus minimizing morbidity and the need for reoperation.