Disconnected Pancreatic Duct Syndrome: Spectrum of Operative Management

Thomas K. Maatman, Alexandra M. Roch, Kyle A. Lewellen, Mark A. Heimberger, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, C. Max Schmidt, Nicholas J. Zyromski

Research output: Contribution to journalArticle

Abstract

Background: Disconnected pancreatic duct syndrome (DPDS) is common after necrotizing pancreatitis (NP). Surgical management may be by internal drainage or left (distal) pancreatectomy. Therapeutic decision-making must consider sinistral portal hypertension, parenchymal volume of disconnected pancreas, and timing relative to definitive management of pancreatic necrosis. The aim of this study is to evaluate outcomes after operative management for DPDS. Methods: All patients with NP undergoing an operation for DPDS were included in the study (2005-2017). Perioperative outcomes and long-term durability were evaluated. Results: Among 647 patients with NP, 299 (46%) had DPDS. Operative management was required in 202/299 (68%) patients with DPDS. Median follow-up was 30 mo (2-165). Definitive operative therapy included internal drainage (n = 111) or resection (n = 91). Time from NP diagnosis to operation was 126 d (20 d to 81 mo). Overall morbidity was 46%. Postoperative length of stay was 7 d (2-97). Readmission was required in 39 patients (19%). Mortality was 2%. Repeat pancreatic intervention was required in 23 patients (11%) at a median of 15 mo (1-98). Repeat pancreatectomy was performed in nine patients and the remaining 14 patients were managed with endoscopic therapy. Conclusions: DPDS is a common and challenging consequence of NP. Appropriate operation is durable in nearly 90% of patients.

Original languageEnglish (US)
JournalJournal of Surgical Research
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Pancreatic Ducts
Pancreatitis
Pancreatectomy
Drainage
Portal Hypertension
Pancreas
Length of Stay
Decision Making
Necrosis
Therapeutics
Morbidity
Mortality

Keywords

  • Disconnected pancreatic duct syndrome
  • Necrotizing pancreatitis
  • Pancreatectomy
  • Pancreatojejunostomy
  • Sinistral portal hypertension

ASJC Scopus subject areas

  • Surgery

Cite this

Disconnected Pancreatic Duct Syndrome : Spectrum of Operative Management. / Maatman, Thomas K.; Roch, Alexandra M.; Lewellen, Kyle A.; Heimberger, Mark A.; Ceppa, Eugene P.; House, Michael G.; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.

In: Journal of Surgical Research, 01.01.2019.

Research output: Contribution to journalArticle

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AU - Maatman, Thomas K.

AU - Roch, Alexandra M.

AU - Lewellen, Kyle A.

AU - Heimberger, Mark A.

AU - Ceppa, Eugene P.

AU - House, Michael G.

AU - Nakeeb, Attila

AU - Schmidt, C. Max

AU - Zyromski, Nicholas J.

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N2 - Background: Disconnected pancreatic duct syndrome (DPDS) is common after necrotizing pancreatitis (NP). Surgical management may be by internal drainage or left (distal) pancreatectomy. Therapeutic decision-making must consider sinistral portal hypertension, parenchymal volume of disconnected pancreas, and timing relative to definitive management of pancreatic necrosis. The aim of this study is to evaluate outcomes after operative management for DPDS. Methods: All patients with NP undergoing an operation for DPDS were included in the study (2005-2017). Perioperative outcomes and long-term durability were evaluated. Results: Among 647 patients with NP, 299 (46%) had DPDS. Operative management was required in 202/299 (68%) patients with DPDS. Median follow-up was 30 mo (2-165). Definitive operative therapy included internal drainage (n = 111) or resection (n = 91). Time from NP diagnosis to operation was 126 d (20 d to 81 mo). Overall morbidity was 46%. Postoperative length of stay was 7 d (2-97). Readmission was required in 39 patients (19%). Mortality was 2%. Repeat pancreatic intervention was required in 23 patients (11%) at a median of 15 mo (1-98). Repeat pancreatectomy was performed in nine patients and the remaining 14 patients were managed with endoscopic therapy. Conclusions: DPDS is a common and challenging consequence of NP. Appropriate operation is durable in nearly 90% of patients.

AB - Background: Disconnected pancreatic duct syndrome (DPDS) is common after necrotizing pancreatitis (NP). Surgical management may be by internal drainage or left (distal) pancreatectomy. Therapeutic decision-making must consider sinistral portal hypertension, parenchymal volume of disconnected pancreas, and timing relative to definitive management of pancreatic necrosis. The aim of this study is to evaluate outcomes after operative management for DPDS. Methods: All patients with NP undergoing an operation for DPDS were included in the study (2005-2017). Perioperative outcomes and long-term durability were evaluated. Results: Among 647 patients with NP, 299 (46%) had DPDS. Operative management was required in 202/299 (68%) patients with DPDS. Median follow-up was 30 mo (2-165). Definitive operative therapy included internal drainage (n = 111) or resection (n = 91). Time from NP diagnosis to operation was 126 d (20 d to 81 mo). Overall morbidity was 46%. Postoperative length of stay was 7 d (2-97). Readmission was required in 39 patients (19%). Mortality was 2%. Repeat pancreatic intervention was required in 23 patients (11%) at a median of 15 mo (1-98). Repeat pancreatectomy was performed in nine patients and the remaining 14 patients were managed with endoscopic therapy. Conclusions: DPDS is a common and challenging consequence of NP. Appropriate operation is durable in nearly 90% of patients.

KW - Disconnected pancreatic duct syndrome

KW - Necrotizing pancreatitis

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