Reoperation following Pancreaticoduodenectomy

. The literature on reoperation following pancreaticoduodenectomy is sparse and does not address all concerns. Aim . To analyze the incidence, causes, and outcome of patients undergoing reoperations following pancreaticoduodenectomy. Methods . Retrospective analysis of 520 consecutive patients undergoing pancreaticoduodenectomy from May 1989 to September 2010. Results . 96 patients (18.5%) were reoperated; 72 were early, 18 were late, and 6 underwent both early and late reoperations. Indications for early reoperation were post pancreatectomy hemorrhage in 53 (68%), pancreatico-enteric anastomotic leak in 10 (13%), hepaticojejunostomy leak in 3 (3.8%), duodenojejunostomy leak in 4 (5%), intestinal obstruction in 1 (1.2%) and miscellaneous causes in 7 (9%). Patients reoperated early did not fare poorly on long-term follow up. Indications for late reoperations were complications of index surgery ( n = 12), recurrence of the primary disease ( n = 8), complications of adjuvant radiotherapy ( n = 3), and gastrointestinal bleed ( n = 1). The median survival of 16 patients reoperated late without recurrent disease was 49 months. Conclusion . Early reoperations following pancreaticoduodenectomy, commonly for post pancreatectomy hemorrhage, carries a high mortality due to associated sepsis, but has no impact on long-term survival. Long-term complications related to pancreaticoduodenectomy and adjuvant radiotherapy can be managed successfully with good results.