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Operative intervention for complete pancreatic transection in children sustaining blunt abdominal trauma: revisiting
Matthew J Borkon1, Stephen E Morrow, Elizabeth A Koehler
1Department of Pediatric Surgery, Vanderbilt Medical Center, Nashville, Tennessee 37232-2730, USA. matthew.j.borkon@vanderbilt.edu
Insights
Distal pancreatectomy (DP) and Roux-en-Y distal pancreaticojejunostomy (RYPJ) manage pediatric complete pancreatic transection (CPT). DP allows earlier enteral feeding, while RYPJ preserves pancreatic tissue and spleen with similar outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Complete pancreatic transection (CPT) in children typically requires surgical intervention.
- Distal pancreatectomy (DP) is a common management, but Roux-en-Y distal pancreaticojejunostomy (RYPJ) offers pancreatic tissue preservation.
Purpose of the Study:
- To compare the outcomes of DP versus RYPJ in managing pediatric CPT following blunt abdominal trauma.
Main Methods:
- Retrospective review of pediatric patients with CPT over 15 years.
- Analysis of demographic data, injury grades, and procedural outcomes for DP and RYPJ groups.
Main Results:
- RYPJ patients were younger and had higher-grade injuries than DP patients.
- DP patients achieved full enteral feeds significantly more often than RYPJ patients.
- No significant difference in length of stay or complications between DP and RYPJ when controlling for injury severity.
Conclusions:
- Distal pancreatectomy may facilitate earlier return to full enteral feeds in pediatric CPT.
- Roux-en-Y distal pancreaticojejunostomy is a viable alternative to DP, preserving pancreatic and splenic tissue with comparable outcomes.
Abstract:
Complete pancreatic transection (CPT) in children is managed commonly with distal pancreatectomy (DP). Alternatively, Roux-en-Y distal pancreaticojejunostomy (RYPJ) may be performed to preserve pancreatic tissue. The purpose of this study was to review our experience using either procedure in the management of children sustaining CPT after blunt abdominal trauma. We retrospectively reviewed the records of all children admitted to our institution during the last 15 years who were confirmed at operation to have CPT after blunt mechanisms. Summary statistics of demographic data were performed to describe children receiving either RYPJ or DP. CPT occurred in 28 children: 15 had DP, 10 had RYPJ, and three had cystogastrostomy. RYPJ children, compared with DP, were younger (7.5 vs. 12.3 years, P = 0.039) and sustained more grade IV pancreatic injuries (70% vs. 14%, P = 0.01). DP patients were 5.63 times more likely to tolerate full enteral feeds (P = 0.009). Nevertheless, when controlling for age, injury severity score, and pancreatic injury grade, procedure type did not statistically affect total and postoperative lengths of stay and postoperative complications. In the operative management algorithm of children sustaining CPT, DP may afford an earlier return to full enteral feeds. RYPJ seems otherwise equivalent to DP and preserves significant pancreatic glandular tissue and the spleen.
