P. Hu1, R. Uhlich1, J. Kerby1, P. Bosarge1 1University Of Alabama at Birmingham,Acute Care Surgery,Birmingham, Alabama, USA
Introduction:
Pancreatic injury is a rare, potentially devastating consequence of abdominal trauma. While low grade injuries may be successfully managed conservatively, injuries to the pancreatic duct or head typically require operative intervention. Complications following pancreatic resection are historically associated with high rates of morbidity and mortality. We sought to evaluate the influence of intra-operative techniques on postoperative complications.
Methods:
A retrospective case control study was performed at an American College of Surgeons verified level 1 trauma center from 2011-2017. All adult patients admitted to the trauma surgery service were eligible for inclusion, while patients with pregnancy or age <18 years old were excluded. Patients with pancreatic injury were identified from the trauma registry using ICD-10 codes. Pancreatic injuries were graded according to the AAST guidelines (Grades 1-5), with major injury identified as ≥ grade 3 (pancreatic ductal injury). Patients were stratified into cohorts according to the method used for pancreatic division and resection, including stapled, cut and oversewn, stapled and oversewn, or cautery. Pancreatic leak was defined as a drain amylase level three times greater than normal serum amylase (103 U/L), according to institutional standard. Analysis was performed using χ2 and Student's t-test or one-way ANOVA for categorical and continuous variables respectively. The primary outcome of interest was the rate of pancreatic leak following resection.
Results:
52 patients were identified with pancreatic injury[PLB1] . The majority of patients (90.4%) underwent operative management. Pancreatic resection was required in 40.4% (21/52), with a majority undergoing stapled resection (52.3%). The remaining resections were performed by cut and oversew (14.3%), stapled and oversewn (23.8%), and cautery (9.5%). Pancreatic leak was identified postoperatively in 76.2% (16/21) of patients, with no significant difference between the different types of resection (p=0.27).
Conclusion:
Pancreatic injury requiring resection results in significant rates of postoperative leak, regardless of intraoperative technique. Drain placement should be strongly considered at the time of initial operation