Experience with enteric conversion after pancreatic transplantation with bladder drainage.

BACKGROUND

Bladder drainage by the duodenal segment technique is currently the preferred method of handling the exocrine secretions after vascularized pancreatic transplantation. Despite improving results, however, the management of metabolic and urologic complications associated with bladder drainage remains problematic.

STUDY DESIGN

A retrospective survey was performed of a consecutive case series of 196 pancreatic transplantations in 186 patients with diabetes over an 80-month period. All patients underwent whole organ pancreatic transplantation with bladder drainage by the duodenal segment technique.

RESULTS

A total of 25 conversions (13 percent) from bladder drainage to enteric drainage were performed in 24 patients (24 side-to-side duodenoenterostomies, one Roux-en-Y limb duodenoenterostomy). The mean time of enteric conversion after pancreatic transplantation was 22 +/- 18 months (range, 1 to 72 months). All but two of the enteric conversions were performed at least 6 months after pancreatic transplantation. Indications for enteric conversion included dehydration with intractable metabolic acidosis (n = 18; 9 percent), urologic complications (n = 5; 3 percent), or problems with the duodenal segment (n = 2; 1 percent). The mean length of hospitalization for enteric conversion was 12 +/- 7 days (range, 6 to 30 days). All patients experienced improvement in their symptoms after enteric conversion. Anastomotic leaks developed postoperatively in five patients; two were managed operatively and three were managed nonoperatively. Oral bicarbonate supplementation was eliminated in all but one patient after enteric conversion. Patient survival is 100 percent and pancreatic graft survival (insulin independence) is 96 percent after a mean follow-up of 22 months after enteric conversion.

CONCLUSIONS

Enteric conversion after pancreatic transplantation with bladder drainage is a safe and effective therapy for refractory problems related to the duodenal segment, altered physiologic function, or urologic complications and should be considered after 6 months for patients with persistent side effects.