Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 834-846
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.834
Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit
Juanita Noeline Chui, Krishna Kotecha, Tamara MH Gall, Anubhav Mittal, Jaswinder S Samra
Juanita Noeline Chui, Krishna Kotecha, Tamara MH Gall, Anubhav Mittal, Jaswinder S Samra, Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
Juanita Noeline Chui, Anubhav Mittal, Jaswinder S Samra, Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
Anubhav Mittal, Department of Surgery, University of Notre Dame, Sydney 2006, NSW, Australia
Author contributions: Chui JN contributed to data collection and synthesis, drafting of original manuscript and revisions; Kotecha K contributed to review of manuscript and revisions; Gall TM contributed to review of manuscript and revisions; Mittal A contributed to review of manuscript and revisions; conceptualisation; Samra JS contributed to review of manuscript and revisions; conceptualisation
Institutional review board statement: Research protocol was approved by the Northern Sydney Local Health District ethics committee as a negligible/Low risk project. This study was not a trial or animal study.
Informed consent statement: Data was de-identified and retrospectively collected, and therefore informed consent was not required from each patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juanita Noeline Chui, BSc (Adv), MD, Doctor, Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney 2065, NSW, Australia. juanita.noeline@gmail.com
Received: December 3, 2022
Peer-review started: December 3, 2022
First decision: January 12, 2023
Revised: January 22, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: May 27, 2023
Abstract
BACKGROUND

The management of high-grade pancreatic trauma is controversial.

AIM

To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.

METHODS

A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.

RESULTS

Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.

CONCLUSION

We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.

Keywords: Pancreas, Trauma, Injury, Pancreatectomy, Pancreaticoduodenectomy, Damage control surgery

Core Tip: The management of pancreatic trauma is evolving. This study presents a single-centre series of patients undergoing operative management for pancreatic trauma in Australia. We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Penetrating and blunt trauma presentations are associated with varied patterns of injury. There is a growing role for endovascular and endoscopic techniques in the contemporary management of pancreatic trauma. Pancreatic resections including pancreaticoduodenectomy may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.