Surgical management of pancreatic trauma in Australia

Pancreatic trauma is rare and complex. Non-operative management of pancreatic injuries is often appropriate, and when surgical intervention is required there may be a choice between resectional or more conservative approaches. This is especially true for distal injuries. Operative management of proximal pancreatic injuries is extremely challenging and has less room for conservatism. We sought to characterize the surgical treatment of pancreatic injuries, comparing outcomes for those undergoing formal resection (FR) versus those undergoing more conservative surgical treatment. Our hypothesis was that 'biting the bullet' and resecting is not associated with worse outcomes than less invasive approaches.

All patients undergoing surgery for pancreatic injuries between June 2001 and June 2019 at the Alfred Hospital in Melbourne were included. Outcome measures including length of stay, return to theatre, total parenteral nutrition use, pancreatic fistula, intra-abdominal infection and mortality were compared between patients undergoing FR and those undergoing non-resectional procedures.

Of nearly 60 000 trauma presentations, 194 patients sustained pancreatic injury and 51 underwent surgical intervention. Over 70% were secondary to blunt trauma. There were 27 FR and 22 non-resectional procedures. No major outcome differences were detected. FR was not associated with worse outcomes.

In distal injuries, where there is doubt regarding parenchymal viability or ductal integrity, FR can safely be performed with non-inferior outcomes to more conservative surgery. Patients with high-grade proximal injuries will usually have multiple other injuries and require resuscitation, temporization and staged reconstruction.