Surgical techniques for modular one-stage emergent pancreaticoduodenectomy for blunt abdominal trauma: experiences from three centres and a review of the literature.
Xing Wang, Zitong Zhang, Zhenwei Shen, Tao Jin, Xiaodong Wang, Long Ren, Feng Zhan, Wei Zheng, Kai Li, Wei Cheng, Jingdong Li, Kai Zhang
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Abstract
Background: In this study, we report the use of a complex surgical intervention termed modular one-stage emergent pancreaticoduodenectomy (MOEPD) for the treatment of acute Grade IV or V pancreaticoduodenal injuries in haemodynamically stable patients. We summarize the experiences of surgeons performing MOEPD in 12 patients from 3 centres.
Methods: From 2015 to 2021, the clinical data of patients with blunt abdominal trauma who underwent MOEPD were extracted from three Chinese centres. The patients' perioperative variables were assessed.
Results: All twelve MOEPD cases were analysed. All patients had Grade IV or V pancreatoduodenal injuries and received intensive antishock treatment for haemodynamic stabilization. The mean age of the patients was approximately 45.2 years (22-74 years). Ten patients (83.3%) were male. In contrast to the ten patients who underwent pancreaticoduodenectomy (PD), two patients underwent laparoscopic pancreaticoduodenectomy (LPD). Two patients presented with a combination of severe abdominal injuries. None the patients died in the perioperative period. Five patients (41.7%) experienced postoperative complications. A postoperative pancreatic fistula (POPF) was detected in 16.7% of patients, both of whom recovered within 3-4 weeks with conservative drainage. All patients were released from the institutions after an average of 31.8 days (21-53 days). There was no statistically significant difference in the incidence of complications between the 20 reviewed studies and this group (60.7% vs. 41.7%, P = 0.33), but the mortality rate was lower in this group (26.6% vs. 0%, P = 0.04).
Conclusions: The experiences at these 3 centres suggest that MOEPD may be a lifesaving procedure for haemodynamically stable patients with acute Grade IV or V pancreatoduodenal injuries, despite the small sample size of this study.
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