Treatment of Post-pancreaticoduodenectomy Complications

Pancreaticoduodenectomy is a complex operation that is becoming more common as treatment for both malignant and benign diseases. While postoperative mortality has improved over the last two decades, morbidity continues to remain high. The improvement in mortality is attributed to better perioperative care, including aggressive early diagnosis of complications and a multidisciplinary approach to their treatment. In addition to a high clinical suspicion for postoperative complications, ready access to state of the art diagnostic radiology and endoscopy are essential for the early and accurate diagnosis of complications. After the diagnosis of a complication is made, the patient should have expertise available in interventional radiology, gastroenterology, and hepatobiliary and pancreatic surgery. Optimal treatment may involve any one of these specialties or an orchestrated effort from them all. The need for a critical mass of expertise in many specialties and subspecialties has prompted the development of new tertiary centers devoted to hepaticopancreaticobiliary (HPB) diseases. These HPB centers are becoming more prevalent in the United States as the value of this subspecialty is becoming more recognized. These HPB centers should continue to show improvements in quality and cost of care in treating complex liver, pancreatic, and biliary diseases that have rapidly evolving treatment options.