scholarly journals Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Theodosios Theodosopoulos ◽  
Dionysios Dellaportas ◽  
Anneza I. Yiallourou ◽  
George Gkiokas ◽  
George Polymeneas ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Postoperative Complications ◽  
Survival Rates ◽  
Anastomosis Group ◽  
Morbidity Rate ◽  
Periampullary Cancer ◽  
Pancreatic Stump ◽  
Pancreatic Remnant ◽  
Whipple’S Procedure ◽  
Duration Of Surgery

Introduction. To present our experience regarding the use of pancreatic stump occlusion technique as an alternative management of the pancreatic remnant after pancreatoduodenectomy (PD). Methods. Between 2002 and 2009, hospital records of 93 patients who had undergone a Whipple's procedure for either pancreatic-periampullary cancer or chronic pancreatitis were retrospectively studied. In 37 patients the pancreatic duct was occluded by stapling and running suture without anastomosis of the pancreatic remnant, whereas in 56 patients a pancreaticojejunostomy was performed. Operative data, postoperative complications, oncological parameters, and survival rates were recorded. Results. 2/37 patients of the occlusion group and 9/56 patients of the anastomosis group were treated for chronic pancreatitis, whereas 35/37 and 47/56 patients for periampullary malignancies. The duration of surgery for the anastomosis group was significantly longer (mean time 220 versus 180 minutes). Mean hospitalization time was 6 days for both groups. The occlusion group had a lower morbidity rate (24% versus 32%). With regard to postoperative complications, a slightly higher incidence of pancreatic fistulas was observed in the anastomosis group. Conclusions. Pancreatic remnant occlusion is a safe, technically feasible, and reducing postoperative complications alternative approach of the pancreatic stump during Whipple's procedure.

scholarly journals Pancreatic Resection for Carcinoma of the Pancreas and the Periampullary Region. A Twenty-Year Experience

HPB Surgery ◽  
1990 ◽  
Vol 2 (1) ◽  
pp. 57-67 ◽  
Author(s):  
M. I. Kairaluoma ◽  
M. Ståhlberg ◽  
H. Kiviniemi
Keyword(s):  
Pancreatic Resection ◽  
Survival Rates ◽  
Morbidity Rate ◽  
Periampullary Cancer ◽  
Limiting Factor ◽  
Minimal Risk ◽  
Tumour Histology ◽  
Periampullary Region ◽  
Radical Removal ◽  
Long Term Prognosis

410 patients were treated for pancreatic and periampullary carcinoma in 1968–1987 of whom 89 (21.5%) underwent resection. Hospital mortality decreased from 33% in 1968–1972 to 0% in 1983–1987, but the morbidity rate remained unchanged. The trends were similar in patients ≥ 70 and < 70 years of age. The pylorus-saving technique did not increase mortality, morbidity, operative blood loss or the incidence of delayed gastric emptying, but it did reduce the operative time by one hour (p< 0.01). The real 5 year survival for periampullary cancer was 52%, but none of the patients with pancreatic carcinoma survived for 5 years.It is concluded that age as such is not a limiting factor for pancreatic resection. Resection can be performed with acceptable mortality and survival rates even in patients over 70 years of age if enough attention is paid to careful patient selection and proper preparation. The long-term prognosis is nevertheless related to tumour histology. The recent decline in operative mortality is mostly due to the resections being performed by the same group of surgeons. The best biopsy, and also palliation, is radical removal of the suspicious mass, provided that this can be performed with minimal risk.

Addition of Mesh Reinforcement for Pancreatic Stump and Braun Enteroenterostomy after Pancreaticoduodenectomy: A Single Institution Experience

2018 ◽  
Vol 84 (3) ◽  
pp. 371-376
Author(s):  
Jie Hua ◽  
Hongbo Meng ◽  
Zhigang He ◽  
Le Yao ◽  
Wei Sun ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Pancreatic Stump ◽  
Mesh Reinforcement ◽  
Major Complications ◽  
Postoperative Length ◽  
Braun Enteroenterostomy ◽  
Overall Mortality

The morbidity rate after pancreaticoduodenectomy (PD) remains high and a modified digestive reconstruction may affect the postoperative complications. We investigated a new modification of PD by adding mesh reinforcement for the pancreatic stump and Braun enteroenterostomy with the aim of reducing postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE), respectively. From November 2010 to April 2015, 81 consecutive patients who underwent modified PD were retrospectively reviewed. The clinically relevant POPF and DGE rates were 4.9 and 6.1 per cent, respectively. The overall mortality rate was 2.4 per cent. The incidence of overall postoperative complications was 46.9 per cent, with 17.2 per cent considered as major complications (Clavien grades 3–5). The median postoperative length of hospital stay was 17 days (range 10–119 days). For patients who had major complications, median postoperative length of hospital stay increased significantly (22 vs 13 days, P = 0.001), as compared with those patients with no complications. The new modified digestive reconstruction after PD seems safe and reliable with low clinically relevant POPF and DGE rates. Further prospective controlled trials are essential to support these results.

scholarly journals Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

2021 ◽  
Vol 8 ◽  
Author(s):  
Antonio Giuliani ◽  
Pasquale Avella ◽  
Anna Lucia Segreto ◽  
Maria Lucia Izzo ◽  
Antonio Buondonno ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Postoperative Outcomes ◽  
Cyanoacrylate Glue ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
The Mean

Background: Surgical resection is the only possible choice of treatment in several pancreatic disorders that included periampullar neoplasms. The development of a postoperative pancreatic fistula (POPF) is the main complication. Despite three different surgical strategies that have been proposed–pancreatojejunostomy (PJ), pancreatogastrostomy (PG), and pancreatic duct occlusion (DO)–none of them has been clearly validated to be superior. The aim of this study was to analyse the postoperative outcomes after DO.Methods: We retrospectively reviewed 56 consecutive patients who underwent Whipple's procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit. After pancreatic resection in open surgery, we performed DO of the Wirsung duct with Cyanoacrylate glue independently from the stump characteristics. The mean follow-up was 24.5 months.Results: In total, 29 (60.4%) were men and 19 were (39.6%) women with a mean age of 62.79 (SD ± 10.02) years. Surgical indications were in 95% of cases malignant diseases. The incidence of POPF after DO was 31 (64.5%): 10 (20.8%) patients had a Grade A fistula, 18 (37.5%) Grade B fistula, and 3 (6.2%) Grade C fistula. No statistical differences were demonstrated in the development of POPF according to pancreatic duct diameter groups (p = 0.2145). Nevertheless, the POPF rate was significantly higher in the soft pancreatic group (p = 0.0164). The mean operative time was 358.12 min (SD ± 77.03, range: 221–480 min). Hospital stay was significantly longer in patients who developed POPF (p &lt; 0.001). According to the Clavien-Dindo (CD) classification, seven of 48 (14.58%) patients were classified as CD III–IV. At the last follow-up, 27 of the 31 (87%) patients were alive.Conclusions: Duct occlusion could be proposed as a safe alternative to pancreatic anastomosis especially in low-/medium-volume centers in selected cases at higher risk of clinically relevant POPF.

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

2514 POSTER Pancreatic Remnant Occlusion After Whipple's Procedure: an Alternative Oncologically Safe Method

2011 ◽  
Vol 47 ◽  
pp. S220-S221
Author(s):  
D. Dellaportas ◽  
A. Yiallourou ◽  
E. Ntakomyti ◽  
V. Psychogiou ◽  
A. Fotopoulos ◽  
...  
Keyword(s):  
Safe Method ◽  
Pancreatic Remnant ◽  
Whipple’S Procedure

Comorbidities and indications for total hip arthroplasty at a tertiary care center in Saudi Arabia

2021 ◽  
Vol 12 (3) ◽  
pp. 59-63
Author(s):  
Bandar M Hetaimish ◽  
Eyad A Alakkas ◽  
Khalid F Alharbi ◽  
Abdulrahman M Alradadi ◽  
Habib Y Aletani ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Chronic Diseases ◽  
Hip Arthroplasty ◽  
Common Indication ◽  
Total Hip ◽  
Tertiary Center ◽  
Duration Of Surgery ◽  
Post Traumatic

Objectives: Total hip arthroplasty (THA) is one of the most effective orthopedic interventions for the treatment of patients with advanced‑ stage hip disease. However, reports regarding indications for primary THA in Saudi Arabia are limited. We aimed to evaluate primary indications for THA and identify associated chronic diseases and postoperative complications in THA patients at a tertiary hospital in Saudi Arabia. These are important to provide knowledge on types of hip diseases and variables that may affect the outcome of this intervention in the Saudi population. Methods: This is a retrospective cohort study of THA cases performed between 2010 and 2019 at a tertiary center in Saudi Arabia. Retrieved data include patients’ ages at the time of surgery, chronic diseases, presurgical diagnosis, site and duration of surgery, and postoperative complications. Results: We identified 83 patients who had undergone primary THA; in regard to comorbidities, 32.5% and 30.1% had hypertension and diabetes mellitus, respectively. The most common indication for THA was degenerative hip osteoarthritis (50.6%), followed by post-traumatic arthritis (22.9%) and hip avascular necrosis (20.5%). Conclusion: Despite the high rate of trauma and accidents in Saudi Arabia, degenerative osteoarthritis remains the most common indication for primary THA. Post-traumatic osteoarthritis is identified as the second major indication for THA.

scholarly journals Comparison of laparoscopic surgery versus traditional laparotomy for the treatment of emergency patients

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988919
Author(s):  
Ning Cui ◽  
Jun Liu ◽  
Haiyan Tan
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Observation Group ◽  
Duration Of Surgery ◽  
Clinical Benefits ◽  
Gastrointestinal Emergency ◽  
And Control

Objective To investigate the clinical efficacy of laparoscopic gastrointestinal emergency surgery and postoperative complications. Methods Data for 604 patients undergoing emergency gastrointestinal surgery between January 2013 and December 2018 were analyzed retrospectively. Treatment efficacy and postoperative complications were compared between 300 patients (control group) undergoing traditional laparotomy and 304 patients (observation group) undergoing laparoscopic surgery. Results Clinical features were significantly better in the observation group than in the control group, including duration of surgery (59.12 ± 10.31 minutes vs. 70.34 ± 12.83 minutes), intraoperative blood loss (41.21 ± 10.45 mL vs. 61.38 ± 9.97 mL), postoperative pain score (1.25 ± 0.25 points. vs. 5.13 ± 0.43 points), length of hospital stay (5.13 ± 0.24 days vs. 7.05 ± 0.13 days), and time to free activity (13 ± 2.96 hours vs. 22 ± 3.02 hours). The total complication incidence in the observation group was 3.9%, compared with 16% in the control group (16%). No significant differences in direct medical costs were recorded between the observation and control groups. Conclusions For patients undergoing emergency gastrointestinal surgery, laparoscopic surgery resulted in better clinical outcomes than traditional laparotomy without incurring additional costs. The potential clinical benefits of emergency laparoscopic gastrointestinal surgery warrant further study.

scholarly journals Subtotal Pancreatectomy for Cancer: Closure of the Pancreatic Remnant With Staplers

HPB Surgery ◽  
1990 ◽  
Vol 2 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Bo Ahrén ◽  
Karl-G. Tranberg ◽  
Åke Andrén-Sandberg ◽  
Stig Bengmark
Keyword(s):  
Fatal Outcome ◽  
Endocrine Function ◽  
Periampullary Cancer ◽  
Gastric Stasis ◽  
Subtotal Pancreatectomy ◽  
Pancreatic Remnant ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Pancreatic Endocrine Function

This paper presents a 2-year series of 26 consecutive pancreatectomies for periampullary cancer where the pancreatic tail was closed with a stapler in order to avoid complications related to a pancreatico-digestive anastomosis. The follow-up period was 14 months or more. Seven patients developed operative complications. Pancreatic fistulas developed in 3 patients. The fistulas closed spontaneously in 2 of the patients after 2-4 months, lntraabdominal abscesses developed in 4 patients and required surgical drainage. In 1 of these patients, the abscess eroded a large vessel with a fatal outcome resulting in an operative mortality rate of 3.8%. A transient postoperative gastric stasis was observed in seven patients. Postoperative hospital median stay was 27 days (range 10–83 days). Eighteeen patients have died after 4–30 months in recurrent disease and seven patients are alive after a follow-up period of 15–29 months. Pancreatic endocrine function seemed well preserved; diabetes mellitus has developed in only one patient. In conclusion, it appears that subtotal pancreatectomy with closure of the pancreatic remnant with staples gives a low morbidity and mortality. Although the conclusion should be tempered by the small number of patients, the results justify continued evaluation of this technique with long-term follow-up.

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