Pancreatic Injury Clinical Trial
Official title:
Damage Control for Severe Duodenal and Combined Duodenal-Pancreatic Injuries: A Retrospective Review
The management of significant duodenal injuries and combined duodenal-pancreatic injuries
continues to be challenging and controversial, and several techniques have been advocated
over the years. One technique surgeons employ is the damage control/planned reoperation
strategy. At the trauma center, the advent of damage control and other planned re-operation
strategies has resulted in an evolution in the investigators management of duodenal
lacerations and combined duodenal-pancreatic injuries. In this retrospective review, the
investigators intend to quantify the investigators change in practice and to report its
outcome compared to previous practice.
Using the OHSU Trauma Laparotomy Outcomes Database, the investigators will identify all
patients receiving trauma laparotomy for a duodenal or duodenal/pancreatic injury for a
period of 20 years, from 1989-2009. A number of data points will be retrieved from patients'
medical records, including but not limited to grade of duodenal injury, mechanism of injury,
Injury Severity Score, and others.
The management of significant duodenal injuries and combined duodenal-pancreatic injuries
continues to be challenging and controversial. Several techniques have been advocated over
the years to prevent the dreaded complications of repair breakdown, fistulization, and
intra-abdominal sepsis. These include duodenal diverticulization, triple tube ostomy, tube
duodenostomy, and pyloric exclusion. These techniques are all designed to decompress, heal
without undue intraluminal pressure or flow. Recently, surgeons have questioned whether
aggressive adjunctive diversion is truly necessary, especially for less severe injuries, and
many have noted complications associated with the reconstructions apart from the injury.
An alternative to routine diversion/decompression/exclusion is the damage control/planned
reoperation strategies following laparotomy for severe visceral injuries that have become
prevalent in the past two decades. Instead of performing a primary duodenal repair with
enteral diversion or decompression in a single operation, many surgeons employ a
surveillance and "touch-up" strategy over the course of 2-4 abdominal explorations. The
abdominal fascia is not closed until the healing phase has commenced and the surgeon feels
confident the repair will hold.
At the trauma center, the advent of damage control and other planned re-operation strategies
as resulted in an evolution in our management of duodenal lacerations and combined
duodenal-pancreatic injuries. The investigators perform noticeably fewer decompression,
diversion, or exclusion procedures and have increasingly relied on serial abdominal
explorations for surveillance of the repair.
In this retrospective review, we intend to quantify our change in practice and to report its
outcome compared to previous practice.
Using the OHSU Trauma Laparotomy Outcomes Database, we will identify all patients receiving
trauma laparotomy in which a duodenal or combined duodenal-pancreatic injury was identified
in a 20-year period from 1989-2009. The medical records of these patients will be reviewed
to confirm duodenal injury and to tabulate other factors.
The patients will be categorized based on management of the duodenal injury, e.g. primary
repair, decompression, diversion, or exclusion. Patients will also be categorized according
to laparotomy strategy, e.g. damage control, planned reoperation, or primary fascial closure
without planned reoperation. Duodenal-related complications will be tabulated and the
various groups compared. The investigators anticipate including up to 50 patients.
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Observational Model: Cohort, Time Perspective: Retrospective
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT05978076 -
Serum Lipase and Severity of Pancreatic Injury.
|