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  • Title: Do preoperative pancreatic stents increase operative morbidity for chronic pancreatitis?
    Author: Schnelldorfer T, Lewin DN, Adams DB.
    Journal: Hepatogastroenterology; 2005; 52(66):1878-82. PubMed ID: 16334798.
    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.
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