[Evaluation of conditioning factors of morbimortality in duodenopacreatectomy in periampullary neoplasms].

Autor:	Targarona J; Médico del servicio 6 B Cirugía de Páncreas, Hospital Edgardo Rebagliati Martins, Lima-Perú. jtargaronam@viabc.com, Pando E, Vavoulis A, Sequeiros J, Garatea R, Rotta C, Barreda L
Jazyk:	Spanish; Castilian
Zdroj:	Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru [Rev Gastroenterol Peru] 2008 Jul-Sep; Vol. 28 (3), pp. 226-34.
Abstrakt:	Objective: The purpose of this study is to define the factors that condition complications and mortality in a group of 119 patients with periampullary neoplasms operated on at a general hospital. Materials and Method: Between October 2002 and December 2006, 119 patients who were diagnosed with periampullary neoplasms and underwent a pancreatoduodenectomy at Rebagliati Hospital were evaluated. Results: Age and sex were not conditioning factors of complications. A significant difference in the type of pancreatic anastomosis used was noticed, whereby telescoping was a conditioning factor of complication (p<0.009) compared with mucous-mucous anastomosis.After analyzing the bleeding associated with each complication, a significant connection was established between the greatest bleeding volume obtained in the operating room with the development of pancreatic fistulas (p<0.03), re-operation (p<0.01), abscesses (p<0.006) and intestinal fistulas (p<0.001).The complications related to mortality in patients who underwent a pancreatoduodenectomy (PD) were evaluated. It was observed that pancreatic fistulas (p<0.003), intestinal fistulas (p<0.003) and gallbladder fistulas (p<0.03), intra-abdominal hemorrhaging and bleeding during a standard operating procedure (SOP), transfusions and re-operations were factors that increased mortality significantly. When the surgeon was evaluated as a factor of morbimortality, it was proven that there was a connection between the surgical volume and the incidence of complications and mortality.There was a shorter hospital stay, a lower incidence of intra-operative bleeding and lower morbimortality in the high surgical volume group. Conclusions: The most-feared complications, since they are directly related to mortality, are intestinal fistulas, intra-abdominal hemorrhaging, intra-abdominal abscesses, gallbladder fistulas and the need to undergo repeated operations. Both complications and mortality are directly related to the surgeon factor, which, according to our analysis is the most important factor in decreasing costs, morbidity and mortality in this type of surgery.
Databáze:	MEDLINE
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