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fistula pancreas

Vishal Gupta, Saket Kumar, Vivek Gupta, Pradeep Joshi, Rahul Rahul, Rakesh Kumar Yadav, Amit Dangi, Abhijit Chandra
BACKGROUND: Blumgart's pancreaticojejunostomy (PJ) has been described with low pancreatic leak rates. This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative outcomes. METHODS: We performed a single-center retrospective analysis of a cohort of 81 patients who underwent pancreaticoduodenectomy in our department from January 2011 to February 2018. The primary endpoint was the occurrence of a clinically relevant postoperative pancreatic fistula (CR-POPF) and analysis of its risk factors...
January 31, 2019: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Michael J Minarich, Roderich E Schwarz
Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. Seventy-five of 294 pancreatectomy patients underwent DP (26%). There were 33 men and 42 women, with a median age of 61 years (range: 18-85 years). Underlying conditions included cancer (60%) and benign processes (40%)...
November 1, 2018: American Surgeon
Safi Dokmak, Fadhel Samir Ftériche, Roberto Luca Meniconi, Béatrice Aussilhou, Igor Duquesne, Genaro Perrone, Chihebeddine Romdhani, Jacques Belghiti, Philippe Lévy, Olivier Soubrane, Alain Sauvanet
INTRODUCTION: Risk factors of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (LDP) are not well known and were studied, including the stapler cartridge size and drainage modality. METHODS: Between January 2008 and December 2016, 181 LDP were performed and the pancreas was sectioned by stapler in 130 patients (72%). Patients received white (2.5 mm), blue (3.5 mm), or green (4.1 mm) staplers and the size was not based on any pre or peroperative randomization...
February 9, 2019: Langenbeck's Archives of Surgery
Masaki Morimoto, Soichiro Honjo, Teruhisa Sakamoto, Takuki Yagyu, Ei Uchinaka, Masataka Amisaki, Joji Watanabe, Manabu Yamamoto, Yoji Fukumoto, Naruo Tokuyasu, Keigo Ashida, Hiroaki Saito, Yoshiyuki Fujiwara
OBJECTIVES: It is widely accepted that postoperative pancreatic fistula (POPF) accompanied by bacterial infection results in a worse outcome than POPF alone. However, few studies evaluating predictive indicators of POPF have focused on bacterial infection. METHODS: A consecutive 100 patients who underwent pancreaticoduodenectomy at our institute for periampullary disease were enrolled. POPF was assessed according to the International Study Group of Pancreatic Fistula consensus guidelines; grades B and C were defined as clinically relevant POPF (CR-POPF)...
January 29, 2019: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Shun Kurose, Kentaro Inoue, Shinichiro Yoshino, Ken Nakayama, Sho Yamashita, Keiji Yoshiya, Ryosuke Yoshiga, Koichi Morisaki, Keizo Kaku, Yasuhiro Okabe, Tadashi Furuyama, Yoshihiko Maehara
Pseudoaneurysm after pancreas transplantation has a reported incidence of 1.4% to 8.0% and may be caused by perioperative infection. Subsequent pseudoaneurysm rupture is a rare cause of arterioenteric fistula. Only 28 cases of arterioenteric fistula after pancreas transplantation have been reported in the past 20 years. We experienced a rare case of arterioenteric fistula resulting from pseudoaneurysm rupture after pancreas transplantation. We successfully treated the arterioenteric fistula with multi-staged bridge therapy composed of initial endovascular aneurysm repair, secondary isolation of the fistula, and definitive open repair with extra-anatomic bypass...
January 31, 2019: Annals of Vascular Surgery
T M Mackay, U F Wellner, L B van Rijssen, T F Stoop, O R Busch, B Groot Koerkamp, D Bausch, E Petrova, M G Besselink, T Keck
BACKGROUND: Nationwide audits facilitate quality and outcome assessment of pancreatoduodenectomy. Differences may exist between countries but studies comparing nationwide outcomes of pancreatoduodenectomy based on audits are lacking. This study aimed to compare the German and Dutch audits for external data validation. METHODS: Anonymized data from patients undergoing pancreatoduodenectomy between 2014 and 2016 were extracted from the German Society for General and Visceral Surgery StuDoQ|Pancreas and Dutch Pancreatic Cancer Audit, and compared using descriptive statistics...
February 1, 2019: British Journal of Surgery
Nicole Villafane-Ferriol, Katherine A Baugh, Amy L McElhany, George Van Buren, Andrew Fang, Erisha K Tashakori, Jose E Mendez Reyes, Hop S Tran Cao, Eric J Silberfein, Nader Massarweh, Cary Hsu, Omar Barakat, Carl Schmidt, Nicholas J Zyromski, Mary Dillhoff, Joshua A Villarreal, William E Fisher
BACKGROUND: Early drain removal when postoperative day (POD) one drain fluid amylase (DFA) was ≤5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. METHODS: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, comorbidities, and complications...
January 4, 2019: Journal of Surgical Research
Refik Bademci, Pedro S Nunez, Micheal O Temidayo Talabi, Manuel R Blanco, Gemma C Riart, Vicente A Raventós
BACKGROUND: Despite an increase in the number of laparoscopic distal pancreatectomy (LDP) procedures being performed, the long-term oncology and operative results are still unclear. The aim of this study was to present the surgical and long-term results of patients undergoing LDP for the treatment of distal pancreatic tumors. MATERIALS AND METHODS: A retrospective review was made of patients who underwent LDP in our clinic, between 2006 and 2018, and who were diagnosed with pancreas tail, neck, and corpus tumors...
January 22, 2019: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
I Dimitriou, U Bultmann, M Niedergethmann
BACKGROUND: Whether an immediate surgical treatment or preoperative bile drainage (PBD) should be performed in cases of obstructive jaundice caused by a pancreatic carcinoma has been a matter of controversy for decades. The aim of this study based on in-house patient data was to evaluate both the influence of PBD on septic complications and to analyze intraoperative bile samples in patients with PBD in order to formulate current recommendations for antibiotic treatment. MATERIAL AND METHODS: Relevant data from all pancreatic resections performed in this hospital from January 2013 to December 2017 were collected in a prospective database and were retrospectively analyzed...
January 11, 2019: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Rafael Medrano-Guzmán, Marisol Luna-Castillo, Waldo J Chable-Puc, Luis E García-Ríos, Domingo González-Rodríguez, Francisco I Nájera-Domínguez
Introduction: Pancreatic tumors and periampullary tumors have a similar clinical presentation; pancreatoduodenectomy represents the only possibility of cure or of increasing survival; with an average mortality of 5-10% and a morbidity of 20-40%. Objective: To determine the morbidity and mortality secondary to the pancreatoduodenectomy intervention in patients with pancreatic cancer or periampullary tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI (Mexico City) from 2008 to 2013...
2019: Cirugia y Cirujanos
Pamela Milito, Alberto Aiolfi, Emanuele Asti, Emanuele Rausa, Gianluca Bonitta, Luigi Bonavina
BACKGROUND: Laparoscopic distal pancreatectomy with splenectomy is the standard procedure for body and tail pancreatic tumors. Technical difficulties arising from the strict anatomical relationship between pancreas and splenic vessels generally impose a concomitant splenectomy. Previous retrospective studies have shown a reduced risk of postoperative complications and infections in spleen preserved patients, but this is still a debated issue. Aim of this systematic review and meta-analysis was to provide a more robust evidence on the effect of spleen preserving laparoscopic distal pancreatectomy...
December 28, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Jianjun Du, Hongyuan Xue, Jin Hua, Lizhi Zhao, Ziqiang Zhang
BACKGROUND: Totally laparoscopic distal gastrectomy is being increasingly performed. However, an optimal procedure to achieve intracorporeal gastrojejunostomy and jejunojejunostomy for Roux-en-Y reconstruction after laparoscopic distal gastrectomy remains to be established. Compared with the simple and preferable circular-stapled Roux-en-Y reconstruction in open gastrectomy, application of intracorporeal circular-stapled gastrojejunostomy and jejunojejunostomy of Roux-en-Y reconstruction during laparoscopic distal gastrectomy have been limited (no report of intracorporeal circular-stapled jejunojejunostomy) because of the difficulties of intracorporeal purse-string suture and anvil placement...
December 24, 2018: Journal of Surgical Oncology
Ekaterina Petrova, Hryhoriy Lapshyn, Dirk Bausch, Jan D'Haese, Jens Werner, Thomas Klier, Natascha C Nüssler, Jochen Gaedcke, Michael Ghadimi, Waldemar Uhl, Orlin Belyaev, Olga Kantor, Marshall Baker, Tobias Keck, Ulrich F Wellner
BACKGROUND: Postoperative pancreatic fistula (POPF) is a major factor for morbidity and mortality after pancreatic resection. Risk stratification for POPF is important for adjustment of treatment, selection of target groups in trials and quality assessment in pancreatic surgery. In this study, we built a risk-prediction model for POPF based on a large number of predictor variables from the German pancreatic surgery registry StuDoQ|Pancreas. METHODS: StuDoQ|Pancreas was searched for patients, who underwent pancreatoduodenectomy from 2014 to 2016...
November 24, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
S Fedele, C Bizzoca, A Delvecchio, S Lafranceschina, V Papagni, A Picciariello, S Pisicchio, R Basile, L Vincenti
The rate of pancreaticoduodenectomy (PD) performed for both benign and malignant periampullary diseases has increased. In addition, Roux-en-Y reconstruction after distal gastrectomy for cancer or ulcer is still widely used. Therefore, a surgeon may be confronted with a partially- gastrectomized patient who needs a PD. This is a very challenging circumstance for surgeons because of adhesions, bloodstream, anatomical changes and length of the remnant intestine. In our experience, we performed two pancreaticoduodenectomies after distal gastrectomy in patients with periampullary tumors...
November 2018: Il Giornale di Chirurgia
Fichtl Jakub, Skalický Tomáš, Vodička Josef, Třeška Vladislav, Tupý Radek, Hes Ondřej
INTRODUCTION: Benign cystic tumors represent only 2% of all pancreatic tumors (pancreatic cancer - PC). In contrast to malignant cystic tumors, these tumors occur typically in young women. A solid pseudopapillary tumor is a relatively rare affliction representing less than 4% of cystic PC. Although the tumor is considered benign, metastasis, especially to the spleen, has been reported in approximately 0.5-4% patients. Despite R0 resection, vascular and perineural invasion is monitored in 20% of cases...
2018: Klinická Onkologie: Casopis Ceské a Slovenské Onkologické Spolecnosti
Quan Shen, Qing-Feng Jiang, Yu-Wei Tian, Miao Yu, Jiang-Kun Jia, Huan-Zhou Xue
Aims: The aim of this study is to evaluate the therapeutic efficacy of Appleby operation for carcinoma of the body and tail of pancreas. Materials and Methods: From March 2010 to February 2015, Appleby operation was performed in 17 patients with carcinoma of the body and tail of pancreas. The values of fasting plasma blood, body weight (BW), visual analog pain intensity scale (VAS score), and the quality of life indices were evaluated before and 1 day, 1, 2, 6 weeks after surgery...
December 2018: Journal of Cancer Research and Therapeutics
Salvatore Paiella, Matteo De Pastena, Federico Faustini, Luca Landoni, Tommaso Pollini, Deborah Bonamini, Tommaso Giuliani, Claudio Bassi, Alessandro Esposito, Massimiliano Tuveri, Roberto Salvia
BACKGROUND: Central pancreatectomy (CP) is a parenchyma-sparing surgery for benign or low-grade malignant pancreatic tumors. This study aimed to evaluate the safety of the procedure and to analyze the long-term pancreatic function. The age-specific incidence ratio (IR) was calculated based on the incidence of diabetes mellitus in the general Italian population of Italy. MATERIALS AND METHODS: Patients submitted to CP from January 1990 to December 2017 at the Department of General and Pancreatic Surgery of the Pancreas Institute of Verona, Italy, were evaluated...
November 29, 2018: European Journal of Surgical Oncology
Xinxin Shao, Yibin Xie, Quan Xu, Anqiang Sun, Zhenze Wang, Yantao Tian
OBJECTIVES: Postoperative pancreatic fistula (POPF) is a major concern after pancreatoduodenectomy (PD). We recently designed a new anastomotic method to reduce the rate of pancreatic fistula: polytetrafluoroethylene suture buttress-reinforced pancreaticojejunostomy (PBRP). METHODS: An animal model and a computer simulation were used to measure the maximum stress and tensile strength of the pancreas with and without the suture buttresses. Then, a randomized controlled trial (RCT) was performed to compare the outcome of PD between patients who underwent PBRP vs traditional pancreaticojejunostomy (TP)...
December 3, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Benjamin P T Loveday, Nathan Zilbert, Pablo E Serrano, Koji Tomiyama, Amélie Tremblay, Adrian M Fox, Maja Segedi, Martin O'Malley, Ayelet Borgida, Teresa Bianco, Sean Creighton, Anna Dodd, Adriana Fraser, Malcolm Moore, John Kim, Sean Cleary, Carol-Anne Moulton, Paul Greig, Alice C Wei, Steven Gallinger, Neesha Dhani, Ian D McGilvray
BACKGROUND: Stage 3 pancreatic ductal adenocarcinoma (PDAC) is defined by arterial involvement. This study objective was to evaluate outcomes for patients with stage 3 PDAC with potentially reconstructable arterial involvement, considered for neoadjuvant therapy (NAT) and pancreatic resection, and to compare outcomes following arterial (AR) and non-arterial resection (NAR). METHODS: This study included patients from 2009 to 2016 with biopsy-proven stage 3 PDAC who were offered NAT before surgical exploration...
November 21, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Huizhong Liu, Anjiang He, Kun Liu, Zijian Jiang, Fen Zhang, Xiao Li, Yong He, Kaishan Tao, Lin Wang, Shuqiang Yue
BACKGROUND: In pancreatoduodenectomy,the treatment of pancreatic stump is a critical step, pancreaticoduodenectasis and hemorrhage are the two most common complications, which are closely related to the operation of pancreaticojejunostomy and because leaks from this incur major morbidity and mortality. We describe the special technical experience of a modified end-to-side pancreatojejunostomy(mPJ): surgical methods which combine jejunal decompression tube with pancreatic duct jejunal parachute monolayer suture,and report on the outcome of the consecutive 350 patients...
November 10, 2018: European Journal of Surgical Oncology
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