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Indications for enteric conversion after pancreas transplantation with bladder drainage
H W Sollinger1, T M Sasaki, A M D'Alessandro
1Department of Surgery, University of Wisconsin School of Medicine, Madison.
Surgery
|October 1, 1992
Summary
Pancreas transplant patients with bladder drainage may need conversion to enteric drainage for urologic issues. This conversion is safe and effective, resolving complications and improving patient outcomes.
Area of Science:
- Urology
- Transplant Surgery
- Gastroenterology
Background:
- Bladder drainage is the preferred method for pancreas transplantation in North America.
- While successful, bladder drainage can lead to urologic complications requiring alternative drainage techniques.
- Enteric drainage is an alternative for managing these complications.
Purpose of the Study:
- To review the indications and outcomes of converting pancreas transplant patients from bladder drainage to enteric drainage.
- To assess the safety and efficacy of enteric conversion surgery.
Main Methods:
- A retrospective review of 240 pancreas transplantations performed between June 1982 and January 1992.
- Analysis of 16 patients who underwent conversion from bladder to enteric drainage (side-to-side duodenojejunostomy).
- Evaluation of indications, complications, and resolution of urologic problems post-conversion.
Main Results:
- Sixteen (7%) patients required conversion to enteric drainage due to urethral disruption, urine leaks, bleeding, or infection.
- Conversions occurred between 1.5 and 32 months post-transplant.
- All patients experienced resolution of urologic issues, with one instance of an intraabdominal abscess. Patients also discontinued oral bicarbonate therapy.
Conclusions:
- Enteric conversion is a safe and effective procedure for addressing urologic complications after pancreas transplantation with bladder drainage.
- Early consideration of enteric conversion is recommended for persistent urologic problems unresponsive to conservative treatment.