Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts

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

doi:10.1097/TXD.0000000000000698

Transplantation Direct (Jul 2017)

Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts

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

Affiliations

David Al-Adra, MD, PhD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Ian McGilvray, MD, PhD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Nicolas Goldaracena, MD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Vinzent Spetzler, MD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Jerome Laurence, MD, PhD: 3 Royal Prince Alfred Institute of Academic Surgery, University of Sydney, Sydney, Australia.
Andrea Norgate, RN: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Max Marquez, MD, MPH: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Paul Greig, MD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Gonzalo Sapisochin, MD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Jeffrey Schiff, MD: 2 Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Sunita Singh, MD: 2 Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Markus Selzner, MD: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Mark Cattral, MD, Msc: 1 Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

DOI: https://doi.org/10.1097/TXD.0000000000000698
Journal volume & issue: Vol. 3, no. 7
p. e179

Abstract

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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.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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