Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts
Background. Duodenal leak remains a major cause of morbidity and graft loss in pancreas transplant recipients. The role and efficacy of surgical and image-guided interventions to salvage enterically drained grafts with a duodenal leak has yet to be defined. Methods. We investigated the incidence, tr...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2017-07-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000698 |
| _version_ | 1818116907898765312 |
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| author | David Al-Adra, MD, PhD Ian McGilvray, MD, PhD Nicolas Goldaracena, MD Vinzent Spetzler, MD Jerome Laurence, MD, PhD Andrea Norgate, RN Max Marquez, MD, MPH Paul Greig, MD Gonzalo Sapisochin, MD Jeffrey Schiff, MD Sunita Singh, MD Markus Selzner, MD Mark Cattral, MD, Msc |
| author_facet | David Al-Adra, MD, PhD Ian McGilvray, MD, PhD Nicolas Goldaracena, MD Vinzent Spetzler, MD Jerome Laurence, MD, PhD Andrea Norgate, RN Max Marquez, MD, MPH Paul Greig, MD Gonzalo Sapisochin, MD Jeffrey Schiff, MD Sunita Singh, MD Markus Selzner, MD Mark Cattral, MD, Msc |
| author_sort | David Al-Adra, MD, PhD |
| collection | DOAJ |
| description | Background. Duodenal leak remains a major cause of morbidity and graft loss in pancreas transplant recipients. The role and efficacy of surgical and image-guided interventions to salvage enterically drained grafts with a duodenal leak has yet to be defined.
Methods. We investigated the incidence, treatment, and outcome of duodenal leak in 426 pancreas transplantation recipients from 2000 to 2015.
Results. Duodenal leak developed in 33 (7.8%) recipients after a median follow-up of 5.3 (range, 0.5-15.2) years. Most leaks occurred during the first year (n = 22; 67%), and most were located near the proximal and distal duodenal staple line. Graft pancreatectomy was performed in 8 patients as primary therapy because of unfavorable local and/or systemic conditions. Salvage was attempted in 25 patients using percutaneous drainage (n = 4), surgical drainage (n = 4), or surgical repair (n = 17). Percutaneous or surgical drainage failed to control the leak in 7 of these 8 patients, and all 7 ultimately required graft pancreatectomy for persistent leak and sepsis. Surgical repair salvaged 14 grafts, and 13 grafts continue to function after a median follow-up of 2.9 (range, 1.1-6.3) years after repair.
Conclusions. Our study shows that in selected patients a duodenal leak can be repaired successfully and safely in enterically drained grafts. |
| first_indexed | 2024-12-11T04:29:59Z |
| format | Article |
| id | doaj.art-2d5a32180f264b9485acd7750b36c7e1 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-11T04:29:59Z |
| publishDate | 2017-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-2d5a32180f264b9485acd7750b36c7e12022-12-22T01:20:53ZengWolters KluwerTransplantation Direct2373-87312017-07-0137e17910.1097/TXD.0000000000000698201707000-0016Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas AllograftsDavid Al-Adra, MD, PhD0Ian McGilvray, MD, PhD1Nicolas Goldaracena, MD2Vinzent Spetzler, MD3Jerome Laurence, MD, PhD4Andrea Norgate, RN5Max Marquez, MD, MPH6Paul Greig, MD7Gonzalo Sapisochin, MD8Jeffrey Schiff, MD9Sunita Singh, MD10Markus Selzner, MD11Mark Cattral, MD, Msc121 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.3 Royal Prince Alfred Institute of Academic Surgery, University of Sydney, Sydney, Australia.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.2 Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.2 Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.Background. Duodenal leak remains a major cause of morbidity and graft loss in pancreas transplant recipients. The role and efficacy of surgical and image-guided interventions to salvage enterically drained grafts with a duodenal leak has yet to be defined. Methods. We investigated the incidence, treatment, and outcome of duodenal leak in 426 pancreas transplantation recipients from 2000 to 2015. Results. Duodenal leak developed in 33 (7.8%) recipients after a median follow-up of 5.3 (range, 0.5-15.2) years. Most leaks occurred during the first year (n = 22; 67%), and most were located near the proximal and distal duodenal staple line. Graft pancreatectomy was performed in 8 patients as primary therapy because of unfavorable local and/or systemic conditions. Salvage was attempted in 25 patients using percutaneous drainage (n = 4), surgical drainage (n = 4), or surgical repair (n = 17). Percutaneous or surgical drainage failed to control the leak in 7 of these 8 patients, and all 7 ultimately required graft pancreatectomy for persistent leak and sepsis. Surgical repair salvaged 14 grafts, and 13 grafts continue to function after a median follow-up of 2.9 (range, 1.1-6.3) years after repair. Conclusions. Our study shows that in selected patients a duodenal leak can be repaired successfully and safely in enterically drained grafts.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000698 |
| spellingShingle | David Al-Adra, MD, PhD Ian McGilvray, MD, PhD Nicolas Goldaracena, MD Vinzent Spetzler, MD Jerome Laurence, MD, PhD Andrea Norgate, RN Max Marquez, MD, MPH Paul Greig, MD Gonzalo Sapisochin, MD Jeffrey Schiff, MD Sunita Singh, MD Markus Selzner, MD Mark Cattral, MD, Msc Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts Transplantation Direct |
| title | Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts |
| title_full | Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts |
| title_fullStr | Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts |
| title_full_unstemmed | Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts |
| title_short | Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts |
| title_sort | preserving the pancreas graft outcomes of surgical repair of duodenal leaks in enterically drained pancreas allografts |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000698 |
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