P-162

Surgical complications after pancreas transplantation

B. Forgacs, A. Ghazanfar, M. Mitu-Pretorian, G. Di Benedetto, T. Campbell, H. Riad, R. Pararajasingam, N. Parrott, T. Augustine, A. Tavakoli
Manchester Royal Infirmary, Transplant Unit, Manchester, U.K.

Introduction: Complication rates after pancreas transplantation still remain formidable. Several pancreas recipients may require repeat surgery for various indications.

Objective: To review major surgical complications and their management after pancreas transplantation in our centre.

Methods: 226 pancreas transplantations were performed in our centre between June 2001 and March 2011. 176 SPK, 37 PAK and 13 PTA were performed. Clinical data were collected prospectively into an electronic database (Microsoft Excel). All surgical complications, their management and outcomes were analysed.

Results: Duodenal necrosis developed intraoperatively in two patients. The duodenum was excised in both cases and the ducts directly anastomosed to the bladder. Both patients underwent staged enteric conversion subsequently. Two patients developed severe haematuria following transplantation requiring urgent enteric conversion, one led to a severe native pancreatitis. Two recipients had intra-operative ischemia of the head of pancreas. One underwent resection of the head with direct ductal implantation to the bladder. The other had percutaneous pancreatic ductal drainage. A major fistula occurred in 17 patients. These leaks were managed either conservatively or surgically. 8 patients developed mycotic aneurysms. All of them underwent transplant pancreas pancreatectomy. As late complication one patient developed a chronic transplant pancreas pseudo-cyst which was drained into the bladder. A second patient had stenosis of a duodeno-cystostomy with duodenal perforation. The anastomosis was refashioned and the perforation was closed. A bladder drained kidney pancreas recipient whose kidney failed developed a vesico-cutaneous pancreatic fistula leading to severe skin maceration managed by duodeno-cystic disconnection and enteric drainage.

Conclusions: Surgical complications after pancreas transplantation, are challenging and their management often requires innovative decision making based on standard surgical principles.

P-162

Surgical complications after pancreas transplantation

B. Forgacs, A. Ghazanfar, M. Mitu-Pretorian, G. Di Benedetto, T. Campbell, H. Riad, R. Pararajasingam, N. Parrott, T. Augustine, A. Tavakoli
Manchester Royal Infirmary, Transplant Unit, Manchester, U.K.

Introduction: Complication rates after pancreas transplantation still remain formidable. Several pancreas recipients may require repeat surgery for various indications.

Objective: To review major surgical complications and their management after pancreas transplantation in our centre.

Methods: 226 pancreas transplantations were performed in our centre between June 2001 and March 2011. 176 SPK, 37 PAK and 13 PTA were performed. Clinical data were collected prospectively into an electronic database (Microsoft Excel). All surgical complications, their management and outcomes were analysed.

Results: Duodenal necrosis developed intraoperatively in two patients. The duodenum was excised in both cases and the ducts directly anastomosed to the bladder. Both patients underwent staged enteric conversion subsequently. Two patients developed severe haematuria following transplantation requiring urgent enteric conversion, one led to a severe native pancreatitis. Two recipients had intra-operative ischemia of the head of pancreas. One underwent resection of the head with direct ductal implantation to the bladder. The other had percutaneous pancreatic ductal drainage. A major fistula occurred in 17 patients. These leaks were managed either conservatively or surgically. 8 patients developed mycotic aneurysms. All of them underwent transplant pancreas pancreatectomy. As late complication one patient developed a chronic transplant pancreas pseudo-cyst which was drained into the bladder. A second patient had stenosis of a duodeno-cystostomy with duodenal perforation. The anastomosis was refashioned and the perforation was closed. A bladder drained kidney pancreas recipient whose kidney failed developed a vesico-cutaneous pancreatic fistula leading to severe skin maceration managed by duodeno-cystic disconnection and enteric drainage.

Conclusions: Surgical complications after pancreas transplantation, are challenging and their management often requires innovative decision making based on standard surgical principles.