scholarly journals Pancreatic Serous Cystadenomas Report of 8 Cases with a Mean Follow up of 7 Years

HPB Surgery ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 215-217 ◽  
Author(s):  
Alejandro Fabiani ◽  
Gonzalo J. Delía ◽  
Roberto De Rosa ◽  
María T. Pombo ◽  
Oscar Molfino ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Acute Cholangitis ◽  
Serous Cystadenoma ◽  
Malignant Potential ◽  
Cystic Tumor ◽  
Serous Cystadenomas ◽  
Pancreatic Cystic Tumor

Serous cystadenoma of the pancreas are rare tumors and have little or no malignant potential.We report our experience in the management of eight casses of these tumors in the last 22 years. All the patients were women with a mean age of 59 years. All the cysts caused symptoms. Ultrasound and CTscan were useful in the diagnosis of the pancreatic cystic tumor out not in determining the nature of these lesions clear. FNA-biopsy was performed in 6 cases but in only one c se was the diagnosis confirmed. All tumors were resected. Four radical pancreatoduodenectomies, two distal pancreatectomies and two cystectomies were performed. Mean followup was 83.5 months. All patients are alive and with no signs of recurrence. Complications include an external pancreatic fistula, an acute cholangitis and a case of delayed gastric emptying. In all cases the histological diagnosis was serous cystadenoma of the pancreas. We conclude that resection of these tumors is mandatory although they are supposed to be benign, in order to avoid complications and because malignant transformations has been related to nonresective treatment.

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Operation Time ◽  
Major Complication ◽  
Bile Leakage ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Major Complications

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy. Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that the major complication and reoperation rates following isolated pancreaticojejunostomy were lower than with conventional pancreaticojejunostomy (OR=0.35, 95% CI: 0.13–0.96, P=0.04 and OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage , reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy. Conclusions This study showed that isolated pancreaticojejunostomy was associated with fewer major complications and a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

scholarly journals Delayed gastric emptying after pancreatoduodenectomy: comparison between two different pancreatic reconstruction techniques

2019 ◽  
Author(s):  
Satoshi Hayama ◽  
N Senmaru ◽  
Satoshi Hirano
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Frequent Occurrence ◽  
Reconstruction Technique ◽  
Similar Frequency ◽  
Abdominal Complications ◽  
Factors Associated ◽  
Pancreatic Reconstruction

Abstract Background The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Methods A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction. Results The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups. Conclusions Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

Ulcerative reflux esophagitis associated with Clostridium ventriculi following hiatoplasty – is antibiotic treatment necessary? A case report

2020 ◽  
Vol 58 (05) ◽  
pp. 456-460
Author(s):  
Martin Heidinger ◽  
Gregor Gorkiewicz ◽  
Oana Freisinger ◽  
Iva Brcic
Keyword(s):  
Gastric Emptying ◽  
Antibiotic Treatment ◽  
Reflux Esophagitis ◽  
Delayed Gastric Emptying ◽  
Amplicon Sequencing ◽  
Study Groups ◽  
Barium Swallow ◽  
Biopsy Material ◽  
Oxyntic Mucosa

AbstractClostridium (C.) ventriculi (known as Sarcina ventriculi) is a ubiquitous gram-positive, anaerobic, acidophilic coccus found in patients with gastric motility disorders. The microorganisms can be identified histologically by their characteristic presentation in tetrads or packets of 8 in hematoxylin and eosin stains. Severe cases of emphysematous gastritis or gastric perforation have been described. Nevertheless, the significance of C. ventriculi in an upper gastrointestinal tract and its pathogenic character remain unclear. We present a 67-year-old woman who underwent hiatoplasty with gastropexy. After 3 months, she underwent a gastroscopy showing gastroesophageal reflux. Biopsies showed ulcerative reflux esophagitis with presence of C.ventriculi, subsequently confirmed by 16S ribosomal RNA gene amplicon sequencing. The barium swallow study revealed an atonic stomach with delayed gastric emptying. The patient was treated with PPI and domperidone. On follow up, 15 months post-operatively, a control gastroscopy showed a stomach with food residues and reflux-associated small erosions. The Clostridium organisms were detected only in oxyntic mucosa biopsies without erosions or ulcerations. We speculate that the recognition of the organisms in the biopsy material is important and suggests dysmotility disorder. However, in our opinion, the presence of C. ventriculi, even in combination with mucosal damage, does not necessarily prompt antibiotic treatment since no complications occurred and inflammation as well as gastric function improved under PPI and prokinetic therapy in our patient. Larger study groups with long-term follow-up are needed to understand whether these organisms could behave as pathogens or are only bystanders in the setting of delayed gastric emptying.

scholarly journals A technique for decreasing delayed gastric emptying in the setting of pancreatic fistula

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S841-S842
Author(s):  
B.A. Sayed ◽  
C.A. Moulton ◽  
P. Greig ◽  
I. McGilvray ◽  
S. Gallinger ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying

Pancreatic Fistula and Delayed Gastric Emptying Are the Highest-Impact Complications After Whipple

2020 ◽  
Vol 250 ◽  
pp. 80-87 ◽  
Author(s):  
Jennifer A. Mirrielees ◽  
Sharon M. Weber ◽  
Daniel E. Abbott ◽  
Caprice C. Greenberg ◽  
Rebecca M. Minter ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Meta Analysis ◽  
Operation Time ◽  
Bile Leakage ◽  
Reoperation Rate ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.Conclusions This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

scholarly journals Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy

2020 ◽  
Author(s):  
Satoshi Hayama ◽  
N Senmaru ◽  
Satoshi Hirano
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Frequent Occurrence ◽  
Reconstruction Technique ◽  
Similar Frequency ◽  
Abdominal Complications ◽  
Factors Associated ◽  
Pancreatic Reconstruction

Abstract Background: The association between delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) and pancreatic reconstruction technique remain unclear. The aim of this study is to investigate whether the occurrence of DGE differs between pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) . Methods: A total of 83 patients who underwent subtotal stomach-preserving pancreatoduodenectomy was retrospectively analyzed, and the factors associated with clinically relevant DGE were explored. These patients were divided into a PG group and a PJ group according to the pancreatic reconstruction. DGE occurrence and its association with intra-abdominal complications was compared between the two types of pancreatic reconstruction. Results: The overall incidence of DGE was 27.7%. Intra-abdominal complications including pancreatic fistula were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. In addition, DGE with intra-abdominal complications tended to be more frequent in PG, despite the fact that intra-abdominal complications occurred at a similar frequency in both groups. Conclusions: Intra-abdominal complications were strongly associated with DGE. As to the pancreatic reconstruction, DGE developed more frequently in the PG than in the PJ. We speculate that intra-abdominal complications affected patients with PG more and resulted in frequent occurrence of DGE.

Outcomes of Minimally Invasive Esophagectomy without Pyloroplasty: Analysis of 109 Cases

2010 ◽  
Vol 76 (10) ◽  
pp. 1135-1138 ◽  
Author(s):  
Ninh T. Nguyen ◽  
Chirag Dholakia ◽  
Xuan-Mai T. Nguyen ◽  
Kevin Reavis
Keyword(s):  
Gastric Emptying ◽  
Minimally Invasive ◽  
Delayed Gastric Emptying ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Function ◽  
Invasive Esophagectomy ◽  
Significant Difference ◽  
Botox Injection

Pyloroplasty is performed during esophagectomy to avoid delayed gastric emptying. However, studies have shown that gastric function is minimally impaired even without a pyloroplasty when a gastric tube rather than the whole stomach is used for reconstruction. The aim of this study was to evaluate outcomes of minimally invasive esophagectomy without performance of a pyloroplasty. We performed a retrospective review of 145 patients who underwent a minimally invasive esophagectomy. The 30-day mortality was 2.1 per cent with an in-hospital mortality of 3.4 per cent. Of the 140 patients with more than 90 days follow-up, 31 patients had a pyloroplasty and 109 patients did not. One (3.2%) of 31 patients with pyloroplasty versus six (5.5%) of 109 patients without pyloroplasty developed delayed gastric emptying. There was no significant difference in the leak rate between the two groups (9.7% vs 9.6%, respectively). Total operative time was significantly shorter in the group without pyloroplasty (360 vs 222 minutes with a pyloroplasty, P < 0.01). Patients with delayed gastric emptying responded well to endoscopic pyloric dilation or Botox injection. The routine performance of a pyloroplasty during minimally invasive esophagectomy can be safely omitted with a reduction in operative time and minimal adverse effects on postoperative gastric function.

Comparison between Laparoscopic Paraesophageal Hernia Repair with Sleeve Gastrectomy and Paraesophageal Hernia Repair Alone in Morbidly Obese Patients

2009 ◽  
Vol 75 (7) ◽  
pp. 620-625 ◽  
Author(s):  
Aziz M. Merchant ◽  
Michael W. Cook ◽  
Jahnavi Srinivasan ◽  
S. Scott Davis ◽  
John F. Sweeney ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Gastric Emptying ◽  
Hernia Repair ◽  
Antireflux Surgery ◽  
Paraesophageal Hernia ◽  
Delayed Gastric Emptying ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Paraesophageal Hernia Repair

Treatment options for morbidly obese patients with complications from large paraesophageal hernias (PEH) are limited. Simple repair of the PEH has a high recurrence rate and may be associated with poor gastric function. We compared a series of patients who underwent repair of large PEH plus gastrostomy tube gastropexy (PEH-GT) with PEH plus sleeve gastrectomy (PEHSG). Retrospective review of patients undergoing PEH-SG and patients with PEH-GT was performed. We assessed symptoms of delayed gastric emptying and reflux postoperatively. In selected patients, gastric-emptying studies and upper gastrointestinal contrast studies were also obtained. All patients with large PEH were repaired laparoscopically with sac resection, primary crural closure using pledgeted sutures, and biologic patch onlay. SG for patients undergoing concomitant weight loss surgery (PEH-SG) was performed with linear endoscopic staplers and staple line reinforcement. Patients undergoing PEH repair alone had a gastrostomy tube gastropexy (PEH-GT). Patients had intraoperative endoscopic evaluation and postoperative contrast swallow studies. In a 12-month period, five patients underwent laparoscopic PEH-SG; two of five had previous antireflux surgery and one of five with a previous diagnosis of delayed gastric emptying. Postoperatively, two patients undergoing PEH-SG had readmission for dehydration and odynophagia. Six-month follow-up body mass index was 32 kg/m2 for the PEH-SG group with no hernia recurrence and complete resolution of gastroesophageal reflux disorder symptoms. Six patients underwent PEH-GT, one for acute incarceration and anemia and four with previous antireflux surgery. Follow up at 8 months demonstrated one recurrence, four of six had severe delayed gastric emptying and reflux, three of six had additional hospitalization for poor oral intake, and three of six underwent reoperation for delayed gastric emptying. There were no perforations, leaks, or deaths in either group. Combined laparoscopic PEH-SG is a clinically reasonable option for patients with morbid obesity with minimal additional risks and decreased incidence of delayed gastric emptying, reflux, and reoperation.

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