Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

Background and objective: most acute pancreatitis cases are of biliary origin and cholecystectomy is recommended to prevent recurrence. However, some patients will never be referred for surgery. In this study, the long-term follow-up of this group of patients was reviewed.Methods: all new cases of biliary pancreatitis from January 2015 to December 2017 that did not undergo cholecystectomy were analyzed. Epidemiologic data and Charlson’s comorbidity index (CCI) were recorded. Recurrent episodes of pancreatitis or biliary events and mortality during the follow-up period were recorded.Results: a total of 104 patients were included in the study (30.4 % of all biliary pancreatitis cases) and the median age was 82 years (range, 27-96). Average CCI was 5 (range, 0-18) and the median follow-up period was 37 months (range, 1-70). A total of 41 patients (39.4 %) had gallstone-related complications. Twenty-three patients (22,1 %) had recurrent pancreatitis and 34 (32,7 %) developed biliary events. Twenty-five patients died during follow-up (24 %) but only in 6 (5,8 %) was death due to gallstone-related complications. Non-related mortality was 15.5 % in patients who refused surgery and 25 % in multiple-comorbidity patients.Conclusion: patients who did not undergo cholecystectomy were at high risk for biliary events and pancreatitis recurrence. Conservative treatment and surgical abstention should be individualized and reserved for patients with multiple comorbidities with a short life expectancy. (AU)

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study.

BACKGROUND AND OBJECTIVE: most acute pancreatitis cases are of biliary origin and cholecystectomy is recommended to prevent recurrence. However, some patients will never be referred for surgery. In this study, the long-term follow-up of this group of patients was reviewed. METHODS: all new cases of biliary pancreatitis from January 2015 to December 2017 that did not undergo cholecystectomy were analyzed. Epidemiologic data and Charlson's comorbidity index (CCI) were recorded. Recurrent episodes of pancreatitis or biliary events and mortality during the follow-up period were recorded. RESULTS: a total of 104 patients were included in the study (30.4 % of all biliary pancreatitis cases) and the median age was 82 years (range, 27-96). Average CCI was 5 (range, 0-18) and the median follow-up period was 37 months (range, 1-70). A total of 41 patients (39.4 %) had gallstone-related complications. Twenty-three patients (22,1 %) had recurrent pancreatitis and 34 (32,7 %) developed biliary events. Twenty-five patients died during follow-up (24 %) but only in 6 (5,8 %) was death due to gallstone-related complications. Non-related mortality was 15.5 % in patients who refused surgery and 25 % in multiple-comorbidity patients. CONCLUSION: patients who did not undergo cholecystectomy were at high risk for biliary events and pancreatitis recurrence. Conservative treatment and surgical abstention should be individualized and reserved for patients with multiple comorbidities with a short life expectancy.

Recurrencia de coledocolitiasis tras exploración laparoscópica de la vía biliar principal / Choledocholithiasis recurrence following laparoscopic common bile duct exploration

Introducción: La coledocolitiasis puede tratarse mediante abordaje endoscópico por colangiopancreatografía endoscópica retrógrada o realizando una exploración laparoscópica de la vía biliar principal (ELVBP) durante la colecistectomía. La recurrencia de la coledocolitiasis y sus factores de riesgo tras extracción endoscópica han sido ampliamente investigados. Nuestro objetivo es analizar los factores de riesgo asociados con la recurrencia de cálculos en la vía biliar principal después de una ELVBP. Métodos: Los pacientes que se sometieron a ELVBP desde febrero de 2004 a julio de 2016 fueron examinados en un análisis univariante y multivariante para estudiar la asociación de recurrencia de coledocolitiasis con las siguientes variables: sexo; edad; presencia de hepatopatía; dislipemia, obesidad, o diabetes mellitus; cirugía abdominal previa; presencia de colecistitis, colangitis o pancreatitis al diagnóstico; pruebas de función hepática preoperatorias, número de cálculos recuperados; método de limpieza y cierre del conducto biliar común; presencia de litiasis coledocianas impactadas o intrahepáticas; conversión a cirugía abierta y morbilidad postoperatoria. Resultados: Se incluyeron 156 pacientes. La tasa de recurrencia de la coledocolitiasis fue del 14,1%, con un tiempo medio de recurrencia de 38,18 meses. La edad fue el único factor de riesgo independiente para la recurrencia de cálculos en el análisis univariante y multivariante. Ningún paciente menor de 55 años desarrolló nuevos cálculos en la vía biliar principal, y el 86,4% de las recurrencias se produjo en pacientes mayores de 65 años. Conclusiones: La edad es el único factor de riesgo independiente asociado a la recurrencia de coledocolitiasis después de ELVBP. Diferentes mecanismos en el desarrollo de cálculos en la vía biliar principal pueden estar presentes para pacientes más jóvenes y de edad más avanzada

Introduction: Choledocholithiasis may be treated following an endoscopic approach or by laparoscopic common bile duct exploration (LCBDE). Stone recurrence following endoscopic management has been extensively investigated. We analyze the risk factors associated with stone recurrence following LCBDE. Methods: Patients who underwent LCBDE from February 2004 to July 2016 were examined in an univariate and multivariate analysis to assess the association of stone recurrence with the following variables: gender; age; hepatopathy; dyslipidemia, obesity or diabetes mellitus; previous abdominal surgery; presence of cholecystitis, cholangitis or pancreatitis; preoperative liver function tests, number of retrieved stones; method of common bile duct clearance and closure; presence of impacted or intrahepatic stones; conversion to open surgery and postoperative morbidity. Results: A total of 156 patients were included. Recurrence rate for choledocholithiasis was 14.1% with a mean time to recurrence of 38.18 month. Age was the only independent risk factor for stone recurrence at univariate and multivariate analysis. No patient aged under 55 years developed new common bile duct stones, and 86.4% of the recurrences occurred in patients aged above 65. Conclusions: Age is the only independent risk factor associated to choledocholithiasis recurrence following LCBDE. Different mechanism in common bile duct stone development may be present for younger and older patients

Choledocholithiasis recurrence following laparoscopic common bile duct exploration. / Recurrencia de coledocolitiasis tras exploración laparoscópica de la vía biliar principal.

INTRODUCTION: Choledocholithiasis may be treated following an endoscopic approach or by laparoscopic common bile duct exploration (LCBDE). Stone recurrence following endoscopic management has been extensively investigated. We analyze the risk factors associated with stone recurrence following LCBDE. METHODS: Patients who underwent LCBDE from February 2004 to July 2016 were examined in an univariate and multivariate analysis to assess the association of stone recurrence with the following variables: gender; age; hepatopathy; dyslipidemia, obesity or diabetes mellitus; previous abdominal surgery; presence of cholecystitis, cholangitis or pancreatitis; preoperative liver function tests, number of retrieved stones; method of common bile duct clearance and closure; presence of impacted or intrahepatic stones; conversion to open surgery and postoperative morbidity. RESULTS: A total of 156 patients were included. Recurrence rate for choledocholithiasis was 14.1% with a mean time to recurrence of 38.18 month. Age was the only independent risk factor for stone recurrence at univariate and multivariate analysis. No patient aged under 55 years developed new common bile duct stones, and 86.4% of the recurrences occurred in patients aged above 65. CONCLUSIONS: Age is the only independent risk factor associated to choledocholithiasis recurrence following LCBDE. Different mechanism in common bile duct stone development may be present for younger and older patients.

Eficacia del sellante de fibrina-colágeno para reducir la incidencia de fístulas biliares tras la exploración laparoscópica de la vía biliar / Efficacy of fibrin-collagen sealant for reducing the incidence of biliary fistulae after laparoscopic exploration of the bile duct

No disponible

Eficacia del sellante de fibrina-colágeno para reducir la incidencia de fístulas biliares tras la exploración laparoscópica de la vía biliar / Efficacy of fibrin-sealants in reducing biliary leakage following laparoscopic common bile duct exploration

INTRODUCCIÓN: A pesar de la experiencia existente con la exploración laparoscópica de la vía biliar principal (ELVBP) en el tratamiento de la coledocolitiasis y de su eficacia bien demostrada, hay un riesgo de aparición de fístulas biliares de entre un 5 y un 15% tras el cierre de la coledocotomía. Evaluamos la utilidad de los sellantes de fibrina-colágeno para reducir la incidencia de fístulas biliares tras la coledocorrafia laparoscópica. MÉTODOS: Presentamos un análisis retrospectivo de 96 pacientes diagnosticados de coledocolitiasis sometidos a ELVBP desde marzo de 2009 a marzo de 2017. El cierre de la vía biliar se completó mediante coledocorrafia tras colocación de stent plástico transpapilar (CS) o realizando una sutura primaria (CP). La población de estudio fue dividida en dos grupos: pacientes con coledocorrafia cubierta con una lámina de colágeno-fibrina (GL) y pacientes con coledocorrafia sin cubrir (GSL). Se presenta el análisis de incidencia de aparición de fístulas biliares postoperatorias. RESULTADOS: Treinta y nueve pacientes (41%) fueron incluidos en el grupo GL, mientras que el grupo GSL fue formado por los 57 pacientes restantes (59%). Se demostró la homogeneidad de los grupos. La incidencia de fístulas biliares fue del 7,7% (3 pacientes) en el primer grupo y del 14% (8 pacientes) en el segundo (p = 0,338). La lámina de fibrina-colágeno redujo la incidencia de fístulas biliares de forma significativa en el subgrupo de los pacientes con CP (4,5% vs 33%, p = 0,020), siendo un factor protector con una odds ratio de 10,5. CONCLUSIÓN: La lámina de fibrina-colágeno aplicada sobre la coledocorrafia tras un cierre primario de la vía biliar puede tener un papel importante en la reducción significativa de la incidencia de fístulas biliares postoperatorias

INTRODUCTION: In spite of the acquired experience with laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of biliary leakage of 5% to 15% following choledochotomy closure. We evaluate the usefulness of fibrin-collagen sealants to reduce the incidence of biliary fistula after laparoscopic choledochorrhaphy. METHODS: We report a retrospective analysis of 96 patients undergoing LCBDE from March 2009 to March 2017, whose closure of the bile duct was completed by antegrade stenting and choledochorraphy or by performing a primary suture. The study population was divided into two groups according to whether they received a collagen-fibrin sealant covering the choledochorrhaphy or not, analyzing the incidence of postoperative biliary fistula in each group. RESULTS: Thirty-nine patients (41%) received a fibrin-collagen sponge while the bile duct closure was not covered in the remaining 57 patients (59%). The incidence of biliary fistula was 7.7% (3 patients) in the first group and 14% (8 patients) in the second group (P = .338). In patients who underwent primary choledochorraphy, the fibrin-collagen sealant reduced the incidence of biliary leakage significantly (4.5% vs. 33%, P = .020), which was a protective factor with an odds ratio of 10.5. CONCLUSION: Fibrin-collagen sealants may decrease the incidence of biliary fistula in patients who have undergone primary bile duct closure following LCBDE

Efficacy of fibrin-sealants in reducing biliary leakage following laparoscopic common bile duct exploration. / Eficacia del sellante de fibrina-colágeno para reducir la incidencia de fístulas biliares tras la exploración laparoscópica de la vía biliar.

INTRODUCTION: In spite of the acquired experience with laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of biliary leakage of 5% to 15% following choledochotomy closure. We evaluate the usefulness of fibrin-collagen sealants to reduce the incidence of biliary fistula after laparoscopic choledochorrhaphy. METHODS: We report a retrospective analysis of 96 patients undergoing LCBDE from March 2009 to March 2017, whose closure of the bile duct was completed by antegrade stenting and choledochorraphy or by performing a primary suture. The study population was divided into two groups according to whether they received a collagen-fibrin sealant covering the choledochorrhaphy or not, analyzing the incidence of postoperative biliary fistula in each group. RESULTS: Thirty-nine patients (41%) received a fibrin-collagen sponge while the bile duct closure was not covered in the remaining 57 patients (59%). The incidence of biliary fistula was 7.7% (3 patients) in the first group and 14% (8 patients) in the second group (P=.338). In patients who underwent primary choledochorraphy, the fibrin-collagen sealant reduced the incidence of biliary leakage significantly (4.5% vs. 33%, P=.020), which was a protective factor with an odds ratio of 10.5. CONCLUSION: Fibrin-collagen sealants may decrease the incidence of biliary fistula in patients who have undergone primary bile duct closure following LCBDE.

Laparoscopic common bile duct exploration in elderly patients: is there still a difference?

PURPOSE: Although surgery is frequently not the first treatment option in elderly patients diagnosed with common bile duct stones (CBDS) because of the fear of high morbidity and mortality rates, there are few data about the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) in the elderly. METHODS: From February 2004 to January 2012, 94 patients underwent LCBDE at our center. Data about sex, age, comorbidity, American Society of Anesthesiologists (ASA) score, conversion to open surgery and bile duct clearance rate, postoperative complications, need for reoperation, and mortality were analyzed comparing patients of age 70 or older (group A, n=38) with patients aged under 70 (group B, n=56). RESULTS: Elderly patients had significantly more preoperative risk factors. Stone extraction was equally successful in both groups (89.5% in group A vs. 96.4% in group B, P=0.176). Six patients developed medical complications (7.9% in group A vs. 5.4% in group B, P=0.621). Surgical morbidity was equivalent for both groups (13.2% in group A vs. 10.7% in group B, P=0.718). Four patients in each group experienced some grade of bile leakage. Three patients were reoperated (1 patient in group A because of a biliary peritonitis and 2 in group B after an intra-abdominal hemorrhage). There were no mortality cases directly related to surgery. CONCLUSIONS: This study reveals that LCBDE is safe in the elderly patients and results are not different from those described in the general population. Patients with choledocholithiasis should be offered to undergo an LCBDE irrespective of their age at diagnosis.

Flu-like symptoms following radiofrequency liver transection: a new variety of the post-radiofrequency syndrome.

BACKGROUND/AIMS: The aim of our study was to determine whether post-radiofrequency syndrome may also develop following hepatectomy using saline-cooled radiofrequency coagulation. METHODS: We retrospectively reviewed 95 consecutive patients who underwent 110 liver resections between May 2000 and September 2012. We stated that 80.9% of the resections were carried out employing the saline-cooled radiofrequency device. All medical records were searched for the occurrence of flu-like symptoms, without evidence of sepsis or infection, in the first two postoperative weeks. RESULTS: Eleven patients (11.5%) developed flu-like symptoms after hepatectomy without evidence of sepsis or infection. All their hepatectomies were performed employing the saline-cooled radiofrequency probe (p = .089), and all cases but one appeared following colorectal liver metastases surgery (p = .042). Eight of them were readmitted to the hospital because of their symptoms. In all 11 cases, a fluid collection was present, 8 of them with gas presence. Nine patients underwent a percutaneous drainage whose cultures were negative. Ten patients recovered without treatment or with the intake of nonsteroidal anti-inflammatory drugs within 1 week, but one patient developed a secondary infection with gram-positive bacteria after percutaneous drainages that prolonged his hospital stay. CONCLUSION: Liver splitting using saline-cooled radiofrequency coagulation may cause postoperative symptoms that may mimic surgical site infection. Surgeons employing this device should keep this in mind to avoid potentially unwarranted treatments that may be unnecessary, expensive, and even harmful.

Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube.

INTRODUCTION: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS) has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE). MATERIAL AND METHODS: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed followingKehr tube placements in 47 cases and transpapillary biliary stentingwas conducted in the remaining 28 patients. RESULTS: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days) than in the Kehr group (12 ± 10.6 days), with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 %) and to grade C complications in the Kehr group (6.4 vs. 3.6 %). Therewere 3 cases of residual common bile duct stones in the Kehr group (6.4 %) and none in the stent group. CONCLUSIONS: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity.

Exploración laparoscópica de la vía biliar y coledocorrafia sobre prótesis biliar: dejando atrás el tubo de Kehr / Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube

Introducción: el tratamiento de la colecisto-coledocolitiasis por vía laparoscópica en un tiempo ha demostrado resultados comparables a la colecistectomía laparoscópica asociada a CPRE. Clásicamente, la coledocorrafia se ha realizado sobre un tubo en T para permitir la derivación externa del flujo biliar. Sin embargo, su retirada está asociada a una significativa tasa de complicaciones. El uso de prótesis biliares anterógradas, evita toda la morbilidad asociada a la retirada del tubo en T. En este estudio, comparamos los resultados entre la coledocorrafia sobre Kehr vs. prótesis biliar en nuestra serie de colédoco-litotomía laparoscópica. Material y métodos: entre 2004 y 2011, hemos intervenido 75 pacientes de colecisto-coledocolitiasis por vía laparoscópica, realizando en 47 casos la coledocorrafia sobre un tubo de Kehr y sobre prótesis biliar transpapilar en los 28 restantes. Resultados: la estancia postoperatoria fue menor en el grupo prótesis (5 ± 10,26 días) que en el grupo Kehr (12 ± 10,6 días), siendo estadísticamente significativa. Se observó una mayor tendencia a las complicaciones grado B en el grupo prótesis (10,7 vs. 4,3 %) y complicaciones grado C en el grupo Kehr (6,4 vs. 3,6 %). La tasa de coledocolitiasis residual fue de 3 casos en el grupo Kehr (6,4 %) y ninguno en el grupo prótesis. Conclusiones: la coledocorrafia sobre prótesis biliar transpapilar por vía laparoscópica es una técnica efectiva y segura para el tratamiento de la colecisto-coledocolitiasis en un único tiempo, evitando todas las complicaciones derivadas del manejo y retirada del tubo de Kehr(AU)

Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS) has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE). Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days) than in the Kehr group (12 ± 10.6 days), with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 %) and to grade C complications in the Kehr group (6.4 vs. 3.6 %). There were 3 cases of residual common bile duct stones in the Kehr group (6.4 %) and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity(AU)

Control glucémico y riesgo de progresión del estado diabetológico durante el seguimiento clínico tras duodenopancreatectomía cefálica / Blood glucose control and risk of progressing to a diabetic state during clinical follow up after cephalic duodenopancreatectomy

Introducción La resección pancreática supone un riesgo teórico de desarrollo de diabetes; no obstante, son escasos los estudios que han mostrado el efecto de la duodenopancreatectomía cefálica en el control glucémico postoperatorio. Material y métodos Se revisó el seguimiento clínico postoperatorio de 70 pacientes sometidos a duodenopancreatectomía cefálica entre marzo de 1993 y noviembre de 2009 en nuestro hospital. La indicación quirúrgica se debió a enfermedad primaria pancreática en 30 casos (21 adenocarcinomas de páncreas, 6 pancreatitis crónicas, 1 carcinoma endocrino, 1 cistoadenoma y 1 seudoquiste complicado). En los restantes 40 pacientes el páncreas no estaba afectado (24 carcinomas ampulares, 11 colangiocarcinomas, 3 carcinomas duodenales, 1 adenoma de la papila y 1 hiperplasia adenomiomatosa de la vía biliar). Se recogieron los datos del estado diabetológico pre y postoperatorio. Resultados Antes de la resección, 49 pacientes (70,0%) eran normoglucémicos sin necesidad de tratamiento. Diecisiete pacientes requerían tratamiento antidiabético oral, 3 insulina subcutánea y sólo uno era tratado mediante dieta. La duodenopancreatectomía deterioró el control glucémico en el 47,1% de los pacientes (23 de los previamente no diabéticos y 10 de los tratados con antidiabéticos orales). El control glucémico fue peor cuando la indicación quirúrgica se debió a una afección primaria de la glándula (progresión del 63,3%) en comparación con los pacientes con patología (progresión del 35,0) (p<0,05).Conclusiones Nuestro estudio revela que la resección de la cabeza pancreática favorece la aparición de diabetes postoperatoria, especialmente cuando la indicación quirúrgica se debe a una afección primaria del páncreas (AU)

Introduction: Pancreatic resection carries a theoretical risk of developing diabetes; however few studies have demonstrated the effect of a cephalic duodenopancreatectomy on postoperativeblood glucose control. Material and methods: An analysis was made of the post-operative clinical follow up of 70patients subjected to a cephalic duodenopancreatectomy in our Hospital between March1993 and November 2009. The surgical indication was due to primary pancreatic disease in30 patients (21 adenocarcinoma of the pancreas, 6 chronic pancreatitis, 1 endocrinecarcinoma, 1 cystadenoma and 1 complicated pseudocyst). The pancreas was not affected in the other 40 patients (24 ampullary carcinomas, 11 cholangiocarcinomas, 3 duodenalcarcinomas, 1 papillary adenoma and 1 adenomatous hyperplasia of the bile duct). Data onthe pre- and post-operative diabetic state were collected. Results: Before resection, 49 patients (70.0%) had a normal glucose without the need fortreatment. Seventeen patients required oral diabetic treatment, 3 subcutaneous insulin, and only one was treated by diet. The duodenopancreatectomy worsened glucose control in47.1% of the patients (23 of the previously non-diabetics and 10 of those treated with oraldiabetics). Glucose control was worse when the surgical indication was due to primary involvement of the gland (progression of 63.3%) compared with patients with disease(progression of 35.0%) (P < .05).Conclusions: Our results show that resection of the head of the pancreas favours the appearance of post-operative diabetes, particularly when the surgical indication is due to primary pancreatic involvement (AU)

[Blood glucose control and risk of progressing to a diabetic state during clinical follow up after cephalic duodenopancreatectomy]. / Control glucémico y riesgo de progresión del estado diabetológico durante el seguimiento clínico tras duodenopancreatectomía cefálica.

INTRODUCTION: Pancreatic resection carries a theoretical risk of developing diabetes; however few studies have demonstrated the effect of a cephalic duodenopancreatectomy on post-operative blood glucose control. MATERIAL AND METHODS: An analysis was made of the post-operative clinical follow up of 70 patients subjected to a cephalic duodenopancreatectomy in our Hospital between March 1993 and November 2009. The surgical indication was due to primary pancreatic disease in 30 patients (21 adenocarcinoma of the pancreas, 6 chronic pancreatitis, 1 endocrine carcinoma, 1 cystadenoma and 1 complicated pseudocyst). The pancreas was not affected in the other 40 patients (24 ampullary carcinomas, 11 cholangiocarcinomas, 3 duodenal carcinomas, 1 papillary adenoma and 1 adenomatous hyperplasia of the bile duct). Data on the pre- and post-operative diabetic state were collected. RESULTS: Before resection, 49 patients (70.0%) had a normal glucose without the need for treatment. Seventeen patients required oral diabetic treatment, 3 subcutaneous insulin, and only one was treated by diet. The duodenopancreatectomy worsened glucose control in 47.1% of the patients (23 of the previously non-diabetics and 10 of those treated with oral diabetics). Glucose control was worse when the surgical indication was due to primary involvement of the gland (progression of 63.3%) compared with patients with disease (progression of 35.0%) (P<.05). CONCLUSIONS: Our results show that resection of the head of the pancreas favours the appearance of post-operative diabetes, particularly when the surgical indication is due to primary pancreatic involvement.