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octreotide and fistula

Ashley Dorneden, Garth Olson, Nathan Boyd
OBJECTIVES: Cervical chylous fistula is an uncommon but potentially severe occurrence associated with neck surgery. Methods for treating this problem have inconsistent efficacy and may result in lengthy hospital stays. Negative pressure wound therapy (NPWT) is a highly effective tool in the management of complex wounds. We report 3 cases where NPWT was successfully used to treat chylous fistulas following neck dissection. METHODS: This is a retrospective chart review of 3 patients who developed chylous fistulas after neck dissection and were successfully treated with NPWT...
January 29, 2019: Annals of Otology, Rhinology, and Laryngology
Tomohiko Adachi, Shinichiro Ono, Hajime Matsushima, Akihiko Soyama, Masaaki Hidaka, Mitsuhisa Takatsuki, Susumu Eguchi
BACKGROUNDS: Prior studies have suggested that drain amylase level is a predictive marker for developing pancreatic fistulas (PFs) after pancreaticoduodenectomy (PD). However, means of preventing PF after discovering high drain amylase levels have not been previously established. The purpose of this study was to evaluate the efficacy of a combination drug therapy (using three drugs; gabexate mesilate, octreotide, and carbapenem antibiotics, named as triple-drug therapy [TDT]) regimen in preventing PF for patients with high drain amylase levels on postoperative day (POD) 1 after PD...
February 2019: Journal of Surgical Research
Pankaj Kumar Garg, Jyoti Sharma, Ashish Jakhetiya, Nilokali Chishi
Introduction  A postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality following pancreaticoduodenectomy (PD). A pharmacologic approach using perioperative octreotide, a long-acting somatostatin analog having an inhibitory action on pancreatic exocrine secretion, was proposed to reduce the incidence of the POPF. Despite contradictory results in various randomized controlled trials (RCTs), the prophylactic octreotide has been widely used in the last two decades to reduce the POPF...
October 2018: Surgery Journal
C Y Kong, P Glen
An 84-year-old woman presented with acute worsening of diarrhoea for a few weeks, with a background of chronic diarrhoea over the past 12 months accompanied by weight loss. Computed tomography during this admission revealed air in the biliary tree and resolution of gallstones in keeping with a cholecystocolonic fistula. Owing to her comorbidities, surgical management was deemed not to be the best option. She was trialled on octreotide, a somatostatin analogue, which effectively resolved her symptoms. This case presents an effective and novel method of managing cholecystocolonic fistulas conservatively in a patient where medical therapy is the ceiling of care...
October 24, 2018: Annals of the Royal College of Surgeons of England
Dong Do You, Kwang Yeol Paik, Il Young Park, Young Kyung Yoo
BACKGROUND: Octreotide is known to decrease the rate of postoperative complication after pancreatic resection by diminishing exocrine function of the pancreas. The aim of this study was to evaluate the effect of octreotide in decreasing exocrine excretion of pancreas and preventing pancreatic fistula. MATERIALS AND METHODS: Prospective randomized trial was conducted involving 59 patients undergoing pancreaticoduodenectomy for either malignant or benign tumor, 29 patients were randomized to receive octreotide; 30 patients allotted to placebo...
September 24, 2018: Asian Journal of Surgery
Michael E Kritikos, Martin Oselkin, Nikhil Sharma, Pallavi P Gopal, Douglas C Bigelow, Sean Grady, Robert W Hurst, Bryan A Pukenas, Omar Choudhri, David Kung
Intracranial dural arteriovenous fistulae (DAVF) are rare vascular malformations. They are generally considered to be acquired lesions, often attributed to dural sinus thrombosis and intracranial venous hypertension. The authors encountered a case of DAVF associated with an octreotide-positive vestibular schwannoma. A 46-year-old female had symptoms of right ear congestion accompanied by pulsatile tinnitus and mild hearing loss. Magnetic resonance imaging (MRI) identified a lobulated mass centered at the cerebellopontine angle...
June 27, 2018: Curēus
Brett L Ecker, Matthew T McMillan, Laura Maggino, Charles M Vollmer
BACKGROUND: Improvements in surgical outcomes are predicated on recognizing effective practices with subsequent adaptation. It is unknown whether risk assessment for pancreatic fistula (clinically relevant postoperative pancreatic fistula [CR-POPF]) after pancreaticoduodenectomy (PD) translates to improved patient outcomes at the practice level. STUDY DESIGN: A prospectively collected, single-surgeon career experience (2003 to 2018) of 455 consecutive pancreatectomies (303 PDs and 152 distal pancreatectomies) was examined...
October 2018: Journal of the American College of Surgeons
Soo Ho Lee, Tae Ho Hong
BACKGROUND: Postoperative pancreatic fistula (POPF) is more likely to occur in a soft pancreas compared to a hard pancreas in which fibrosis has progressed. There is almost no leakage at the anastomosis site or cut surface of a hard pancreas. The aim of this study was to induce localized fibrosis at the cut surface of the pancreas in a rat model. METHODS: Thirty-six rats were divided into three groups (group S: normal saline group; group E: ethanol group; and group O: octreotide group)...
February 2018: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Ayman El Nakeeb, Ahmed ElGawalby, Mahmoud A Ali, Ahmed Shehta, Hosam Hamed, Mohamed El Refea, Ahmed Moneer, Ahmed Abd El Rafee
BACKGROUND: The efficacy of octreotide to prevent postoperative pancreatic fistula (POPF) of pancreaticoduodenectomy (PD) is still controversial. This study aimed to evaluate the effect of postoperative use of octreotide on the outcomes after PD. METHODS: This is a prospective randomized controlled trial for postoperative use of octreotide in patients undergoing PD. Patients with soft pancreas and pancreatic duct < 3 mm were randomized to 2 groups. Group I did not receive postoperative octreotide...
February 2018: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Brett L Ecker, Matthew T McMillan, Valentina Allegrini, Claudio Bassi, Joal D Beane, Ross M Beckman, Stephen W Behrman, Euan J Dickson, Mark P Callery, John D Christein, Jeffrey A Drebin, Robert H Hollis, Michael G House, Nigel B Jamieson, Ammar A Javed, Tara S Kent, Michael D Kluger, Stacy J Kowalsky, Laura Maggino, Giuseppe Malleo, Vicente Valero, Lavanniya K P Velu, Amarra A Watkins, Christopher L Wolfgang, Amer H Zureikat, Charles M Vollmer
OBJECTIVE: To identify a clinical fistula risk score following distal pancreatectomy. BACKGROUND: Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to reduce its occurrence remain elusive. METHODS: This multinational, retrospective study of 2026 DPs involved 52 surgeons at 10 institutions (2001-2016)...
January 2019: Annals of Surgery
Chunli Wang, Xin Zhao, Shengyi You
BACKGROUND: The use of octreotide prophylaxis in the prevention of complications after pancreatic resection remains controversial. The aim of this systematic review and meta-analysis was to evaluate the efficacy of octreotide prophylactic treatment to prevent complications after pancreatic resection. METHODS: Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched for eligible studies from 1980 to November 2016 with the limitation of human subjects and randomized controlled trials (RCTs)...
July 2017: Medicine (Baltimore)
Jason Y Chan, Eddy W Wong, S K Ng, C Andrew van Hasselt, Alexander C Vlantis
Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted...
July 2017: Ear, Nose, & Throat Journal
Brett L Ecker, Matthew T McMillan, Horacio J Asbun, Chad G Ball, Claudio Bassi, Joal D Beane, Stephen W Behrman, Adam C Berger, Euan J Dickson, Mark Bloomston, Mark P Callery, John D Christein, Elijah Dixon, Jeffrey A Drebin, Carlos Fernandez-Del Castillo, William E Fisher, Zhi Ven Fong, Ericka Haverick, Robert H Hollis, Michael G House, Steven J Hughes, Nigel B Jamieson, Ammar A Javed, Tara S Kent, Stacy J Kowalsky, John W Kunstman, Giuseppe Malleo, Katherine E Poruk, Ronald R Salem, Carl R Schmidt, Kevin Soares, John A Stauffer, Vicente Valero, Lavanniya K P Velu, Amarra A Watkins, Christopher L Wolfgang, Amer H Zureikat, Charles M Vollmer
OBJECTIVE: The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy. BACKGROUND: The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circumstances of the anastomosis. The Fistula Risk Score (FRS) identifies a distinct high-risk cohort (FRS 7 to 10) that demonstrates substantially worse clinical outcomes...
April 2018: Annals of Surgery
E V Stepan, A S Ermolov, M L Rogal', Yu S Teterin
The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment...
2017: Khirurgiia
Yun-Peng Peng, Xiao-Le Zhu, Ling-Di Yin, Yi Zhu, Ji-Shu Wei, Jun-Li Wu, Yi Miao
Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). However, the risk factors of this complication in patients after DP still remain controversial. The aim of our study is to estimate the association between potential risk factors and POPF. Relevant articles published up to June 21, 2016 were identified via PubMed, EMBASE, Web of Science, and The Cochrane Library. Studies that examined the risk factors of POPF following DP were enrolled. 20 articles (2070 patients) were finally included in this study...
March 15, 2017: Scientific Reports
M D Dibirov, L V Domarev, E A Shitikov, A I Isayev, G S Karsotiyan
INTRODUCTION: Pancreatic necrosis - acute surgical disease accompanying high rates of mortality and complications. MATERIAL AND METHODS: The analysis of the treatment of 256 patients with pancreatic necrosis moderate and severe degrees. In the control group was conducted basic therapy, the main (n=158), which further were administered high doses of octreotide and endoscopic stenting of the main pancreatic duct to decrease the intraductal pressure, prevention and treatment of internal pancreatic fistula...
2017: Khirurgiia
Matthew T McMillan, Amer H Zureikat, Melissa E Hogg, Stacy J Kowalsky, Herbert J Zeh, Michael H Sprys, Charles M Vollmer
Importance: The adoption of robotic pancreatoduodenectomy (RPD) is gaining momentum; however, its impact on major outcomes, including pancreatic fistula, has yet to be adequately compared with open pancreatoduodenectomy (OPD). Objective: To demonstrate that use of RPD does not increase the incidence of clinically relevant pancreatic fistula (CR-POPF) compared with OPD. Design, Setting, and Participants: Data were accrued from 2846 patients who underwent pancreatoduodenectomies (OPDs, n = 2661; RPDs, n = 185), performed by 51 surgeons at 17 institutions worldwide (2003-2015)...
April 1, 2017: JAMA Surgery
Vanessa Phillis Ho, Nimitt J Patel, Faran Bokhari, Firas G Madbak, Jana E Hambley, James R Yon, Bryce R H Robinson, Kimberly Nagy, Scott B Armen, Samuel Kingsley, Sameer Gupta, Frederic L Starr, Henry R Moore, Uretz J Oliphant, Elliott R Haut, John J Como
BACKGROUND: Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. METHODS: The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries...
January 2017: Journal of Trauma and Acute Care Surgery
Jin-Young Jang, Yong Chan Shin, Youngmin Han, Joon Seong Park, Ho-Seong Han, Ho Kyoung Hwang, Dong Sup Yoon, Jae Keun Kim, Yoo Seok Yoon, Dae Wook Hwang, Chang Moo Kang, Woo Jung Lee, Jin Seok Heo, Mee Joo Kang, Ye Rim Chang, Jihoon Chang, Woohyun Jung, Sun-Whe Kim
Importance: The rate of postoperative pancreatic fistula (POPF) after distal pancreatectomy ranges from 13% to 64%. To prevent POPF, polyglycolic acid (PGA) mesh was introduced, but its effect has been evaluated only in small numbers of patients and retrospective studies. Objective: To evaluate the efficacy of PGA mesh in preventing POPF after distal pancreatectomy. Design, Setting, and Participants: Prospective randomized clinical, single-blind (participant), parallel-group trial at 5 centers between November 2011 and April 2014...
February 1, 2017: JAMA Surgery
Koji Takeuchi, Takuya Endoh, Shusaku Hayashi, Takeshi Aihara
BACKGROUND/AIM: Muscarinic acetylcholine receptors exist in five subtypes (M1∼M5), and they are widely expressed in various tissues to mediate diverse autonomic functions, including gastric secretion. In the present study, we demonstrated, using M1∼M5 KO mice, the importance of M4 receptors in carbachol (CCh) stimulation of acid secretion and investigated how the secretion is modulated by the activation of M4 receptors. METHODS: C57BL/6J mice of wild-type (WT) and M1-M5 KO were used...
2016: Frontiers in Pharmacology
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