A hundred consecutive pancreaticoduodenectomies in India
Singhal, Dinesh; Kumar, M.; Gupta, S.; Soni, A.S.; Pandey, R.N. and Nundy, S. (2002) A hundred consecutive pancreaticoduodenectomies in India. In: Proceedings of the Xllth Annual Conference of Indian Association of Surgecal Gastroentrology (IASG), 2002, Delhi, India.
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Background: Pancreaticoduodenectomy in specialized institutions in the USA and other western countries carries a mortality of 3-8%, a morbidity of 40%, a mean hospital stay of 14 days and an average expenditure of 20,000 dollars. In India, where support systems are expensive, there are few large series reporting the results of this operation. We undertook a prospective study of pancreaticoduodenectomy using a dual Roux loop reconstruction and minimal support. Patients and Methods: Between July 1996 and May 2002 we performed 100 pancreaticoduodenectomies. There were 79 males and 21 females (mean age 54 years). The diagnoses were ampullary carcinoma (52), carcinoma of pancreatic head (25), carcinoma of bile duct (12) and duodenal carcinoma (11). To minimize the injurious effects of pancreatic anastomotic leak, the reconstruction was effected using two loops, one for the biliodigestive tract and a separate loop to the pancreatic stump. Except for Inj. Octreotide 150ug tds for 5 days postoperatively, no other support or parenteral nutrition was used. 47 patients were transferred to the ward and 53 to ICU after operation. Results: Morbidity was 41% [pancreatic fistulae (12), delayed gastric emptying (9), wound complications (9) bleeding (3)]. Mortality was 6% [pancreatic fistulae (2), gangrene of Roux loop, hemorrhage, sepsis and myocardial infarction - 1 each. The median hospital stay was 17 days (6-46 days). The average cost of operation was INR 118,000/-(range 70,000/- to 374,000) equivalent to US $ 2300. Conclusions: Pancreatic resections can be performed safely at one tenth of the US cost in India if the dual Roux loop technique is used.
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