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Updated: May 18, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Reoperation after pancreatoduodenectomy: indications, surgical approaches, outcomes, and temporal trends
Laura Veshi1, Jacob Ghotbi1, Anne Waage2
1Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Background:
Reoperation rates after pancreatoduodenectomy vary between centres and may serve as a benchmark of surgical quality and postoperative complication management. This retrospective, single-centre cohort study aimed to categorize reoperations after pancreatoduodenectomy according to indication, timing, and procedure, and to analyse mortality and temporal trends in management.
Methods:
Reoperation indications were classified into four cause-based groups: post-pancreatectomy-specific, vascular, gastrointestinal, and abdominal-wall complications. Temporal trends (2004-2015 vs 2016-2023) and factors associated with postoperative mortality were evaluated.
Results:
Among 1818 pancreatoduodenectomies, 225 patients (12.4%) underwent reoperation within 90 days, with an associated mortality of 13.3%. At first reoperation, post-pancreatectomy-specific complications were the most common indication (66.7%), followed by wound dehiscence (16.9%). The overall reoperation rate did not change over time (13.0% vs 11.7%); however, indications shifted, with a decrease in post-pancreatectomy-specific complications (79.8%-50.5%) and an increase in wound dehiscence (4.0%-32.7%). Management of postoperative pancreatic fistula evolved, with discontinuation of pancreatic duct occlusion and more restrictive use of completion pancreatectomy. Completion pancreatectomy (OR=3.90, p=0.002) and increasing number of reoperations (OR=2.67, p=0.021) were associated with an increase in mortality.
Conclusion:
Reoperation rates after pancreatoduodenectomy remained above 10%. Detailed analysis of reoperations revealed changing patterns over time and identified potential targets for quality improvement.
