Do preoperative pancreatic stents increase operative morbidity for chronic pancreatitis?

Hepatogastroenterology. 2005 Nov-Dec;52(66):1878-82.

Abstract

Background/aims: Recent studies suggest that preoperative placement of bile duct stents increases morbidity after pancreatic surgery. The influence of pancreatic duct stenting on outcome after pancreatic surgery is unknown.

Methodology: The records of 264 consecutive patients who underwent lateral pancreaticojejunostomy, pancreaticoduodenectomy, or distal pancreatectomy for chronic pancreatitis were retrospectively reviewed and analyzed.

Results: There were 137 patients who received preoperative endoscopic pancreatic stents. The remainder underwent preoperative ERCP without stent placement. Both groups had a similar stage of disease measured by endoscopic, clinical, and histological findings. The overall postoperative morbidity was higher in the stent group (19.7% vs. 42.3%, p<0.001, odds ratio 3.0). Intra-abdominal complications occurred more frequently in the stent group (10.2% vs. 32.8%, p<0.001), including a difference in pancreatic leaks. There was no difference in extra-abdominal complications (10.2% vs. 13.1%) and mortality (1.6% vs. 1.5%).

Conclusions: Patients who undergo pancreatic duct stenting and require surgical drainage at a later point have a threefold increased risk for peri-operative complications. An increase in intra-abdominal complications might be related to stent associated pancreatic duct injuries, stent occlusion, and bacterial colonization of the stent.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Length of Stay
  • Male
  • Middle Aged
  • Morbidity / trends
  • Pancreatic Function Tests
  • Pancreaticoduodenectomy / adverse effects
  • Pancreaticoduodenectomy / methods*
  • Pancreaticojejunostomy / adverse effects
  • Pancreaticojejunostomy / methods*
  • Pancreatitis, Chronic / diagnosis
  • Pancreatitis, Chronic / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Preoperative Care / methods
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Stents / adverse effects*