Risk Factors for Complications after Duodenopancreatectomy. Initial Results after Implementing a Standardized Perioperative Protocol
A. Bartoş, D. Bartoş, N. Al-Hajjar, C. Puia, D. Munteanu, R. Bodea, L. Mocan, F. Zaharie, C. IancuOriginal article, no. 3, 2014
Introduction: During 1993-2008 period, in the Surgical ClinicIII were conducted several retrospective studies, in order toidentify risk factors for complications after cephalic duodenopancreatectomy(DP). As a result of these studies, a preoperativeprotocol was developed for preparation of patientsproposed for DPC, as well as a number of intraoperativetechnical changes in order to improve postoperative morbidityand mortality. Implementation of the protocol was graduallyand inomogenic done in our service.Methods: The study is prospective, conducted in 2009-2012, ina group of 180 patients and aims to evaluate immediate resultsafter DPC for periampular malignancy, looking to analyze theeffects of implementation of the protocol mentioned above.We analyzed the rates of complications (pancreatic fistula,bluntpancreatitis, bleeding from the pancreatic blunt, delayedgastric emptiness), and the factors that might influence theiroccurrence.Results and conclusions: of the 180 patients, 10 (5.5%) developedpancreatic fistula and 24 (13.3%) had delayed gastric emptiness. Among the factors that have been significant associatedwiththese complications we mention: the pancreatico-jejunalanastomosis and gastro-jejunal transmesocolic assembly. Withthe implementation of the protocol, the risk factors previouslyidentified in retrospective studies performed in our service(elevated transaminases, experienced surgical team, etc.) havelost significance, but they have not disappeared entirely, due tofact that the conduit proposed was not entirely followed. Webelieve that the homogeneous application of a perioperativeguide, together with a standardized surgical technique, will leadto improve immediate results after DP.
