Computed tomography in planning of the treatment of complications after pancreatic surgery

Abstract

Aim. To evaluate opportunity of computed tomography in diagnosis and decision making in patients with pancreatic surgery complications and possibility of interventional procedures in its treatment.Materials and methods. 50 patients underwent pancreatic surgery in 2018-2020 (45 Whipple procedure and 5 distal pancreatectomies). 45 patients underwent computed tomography in post-surgery course. The complications occur in 29 patients; complications were found by computer tomography in 26 patients.Results. The most frequent complication was pancreatic fistula (24%) in typical places: upper edge of the pancreatojejunostomy (25%) and in the bed of the resected pancreatic head (50%). Delineated fluid collections on computed tomography scans were more prevalent in patients with complicated course (57.9% vs. 26.3%). The average size of fluid collections was increased in the group of complicated courses (51,9 × 28,1 mm vs. 42,2 × 20, 6 mm). Interventional procedures were performed in 18 patients (62% of complicated patients). The average number of such interventions per patient was 2.95. Using interventional techniques as the only method of surgical treatment, 13 patients were cured (50% of complicated patients). In 14 patients, interventions were planned and performed based on control computed tomography. Postoperative bleedings were detected in 8 patients (16%). In 4 cases it revealed ongoing bleeding by computer tomography, in 3 cases – completed, which allowed us to determine further treatment tactics.Conclusion. Performing computed tomography after pancreatic surgery allows to identify postoperative complications before their clinical manifestation and plan their treatment. The optimal time for performing computed tomography is 5–6 days after surgery. Performing CT angiography for suspected bleeding in some cases allows to avoid invasive angiography and choose the method of endovascular hemostasis in appropriate situations. The combination of various interventional techniques allows to avoid relaparotomy in most patients with intraabdominal complications.