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fistula pancreas

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
Ippei Matsumoto, Keiko Kamei, Shumpei Satoi, Takaaki Murase, Masataka Matsumoto, Kohei Kawaguchi, Yuta Yoshida, Toshimitsu Iwasaki, Atsushi Takebe, Takuya Nakai, Yoshifumi Takeyama
PURPOSE: The purpose of the study was to compare the outcomes of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign and low-grade malignant lesions to determine the safety and efficacy of LDP. METHODS: This retrospective comparative study included 67 consecutive patients who underwent LDP (n = 32) and ODP (n = 35) for benign or low-grade malignant lesions of the pancreas from January 2012 to March 2017. Thirty-five patients who were eligible for LDP in the ODP group were carefully selected...
November 22, 2018: Surgery Today
Abhimanyu Varshney, Anjan Kumar Dhua, Vishesh Jain, Sandeep Agarwala, Veereshwar Bhatnagar
Purpose: Whipple's pancreaticoduodenectomy (WPD) is rarely required in children. However, WPD is the only option with pathologies involving the head of the pancreas requiring surgical excision. The objective of our study was to review our experience with WPD performed on children. Materials and Methods: A retrospective analysis of case records was conducted on all patients <18 years of age, who underwent WPD at our center over the last 20 years. Data regarding demographics, signs, and symptoms at presentation, diagnostic imaging and procedures, pathologic reports, surgical and medical treatment, and follow-up were collected to study the indications and safety and outcomes of WPD in children...
October 2018: Journal of Indian Association of Pediatric Surgeons
Luca Moraldi, Benedetta Pesi, Lapo Bencini, Marco Farsi, Mario Annecchiarico, Andrea Coratti
Pancreatic fistula is the main post-operative complication of distal pancreatectomy associated with other further complications, such as intra-abdominal abscesses, wound infection, sepsis, electrolyte imbalance, malabsorption and hemorrhage. Surgeons have tried various techniques to close the stump of the remaining pancreas, but the controversy regarding the impact of stapler closure and suture closure of the pancreatic stump is far from resolved. In this study, we reported our technique and results of robotic assisted distal pancreatectomy with ultrasound identification and consequent selective closure of pancreatic duct...
November 14, 2018: Updates in Surgery
Amine Chhaidar, Mohamed Ben Mabrouk, Ali Ben Ali
OBJECTIVES: The aim of this study was to compare the postoperative outcomes of isolated Roux loop pancreaticojejunostomy (IPJ) and conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy (PD). METHODS: Data of patients who underwent IPJ were compared with those of a pair-matched equal number of patients undergoing CPJ. The matching was performed according to age, gender, nature of the lesion indicating PD and the texture of the pancreas. The primary outcome was the rate of postoperative pancreatic fistula (POPF)...
October 31, 2018: International Journal of Surgery Case Reports
Bülent Aksel, Hikmet Erhan Güven
BACKGROUND: This retrospective comparative case series study aims to analyze the pancreatic fistula rates of internal and external stenting of the pancreatojejunostomy (PJ) anastomosis in patients who underwent pancreatoduodenectomy (PD) for periampullary tumors. METHODS: Ninety-eight patients with periampullary tumors who were operated between 2010 and 2017 were enrolled in this study. A classic open PD with Roux-en-Y PJ reconstruction was performed in all cases...
November 13, 2018: Acta Chirurgica Belgica
Luis Hurtado Pardo, Javier A Cienfuegos, Javier Antoñanzas, Alberto Benito, Pablo Panadero, Joseba Salguero, Pablo Martí-Cruchaga, Gabriel Zozaya, Víctor Valentí, Fernando Pardo, Fernando Rotellar, José Luis Hernández Lizoáin
BACKGROUND: the aim of the present study was to analyze the clinicopathological features of patients undergoing pancreatic surgical resections due to cystic neoplasms of the pancreas. MATERIAL AND METHODS: demographic data, form of presentation, radiologic images and location of the tumors within the pancreas were analyzed. Data was also collected on the type of surgery (open/laparoscopic), postoperative complications and their severity and oncologic outcomes. RESULTS: eighty-two pancreatic resections were performed...
November 8, 2018: Revista Española de Enfermedades Digestivas
Jiri Snajdauf, Michal Rygl, Ondrej Petru, Jiri Nahlovsky, Barbora Frybova, Marianna Durilova, Vladimir Mixa, Radan Keil, Martin Kyncl, Roman Kodet, Adam Whitley
AIM OF STUDY: Duodenum-preserving resection of the pancreatic head (DPRPH) with Roux-en-Y pancreatojejunostomy is a procedure used to remove focal pathological lesions of the pancreatic head. Although predominantly used in adult patients, it is both safe and effective in children. The aim of this study was to review our experience with this procedure, with focus on its indications, complications and long-term outcomes. METHODS: A retrospective analysis of pediatric patients who underwent DPRPH between 1994 and 2015 was performed...
November 1, 2018: Pediatric Surgery International
Shahad Al-Ward, Matt Wronski, Syed Bilal Ahmad, Sten Myrehaug, William Chu, Arjun Sahgal, Brian M Keller
The purpose of this work is to evaluate and quantify the potential radiobiological advantages of tumor tracking using the MR-linac for three disease sites: liver, pancreas and kidney. From each disease site, three patients were selected and 4DCT data sets were used. We applied two planning methods using the Monaco treatment planning system (Elekta AB,Stockholm,Sweden): (1) the conventional ITV method using a 6MV Agility beam and (2) a simulated tracking method using MLC GTV tracking with a 7MV MR-linac beam model incorporating a 1...
October 30, 2018: Physics in Medicine and Biology
Alessandro Crocoli, Chiara Grimaldi, Calogero Virgone, Maria Debora De Pasquale, Giovanni Cecchetto, Simone Cesaro, Gianni Bisogno, Valerio Cecinati, Alessandra Narciso, Daniele Alberti, Andrea Ferrari, Patrizia Dall'Igna, Marco Spada, Alessandro Inserra
BACKGROUND: Solid pseudopapillary pancreatic tumors (SPPT) are an extremely rare entity in pediatric patients. Even if the role of radical surgical resection as primary treatment is well established, data about follow-up after pancreatic resection in children are scant. METHODS: A retrospective review of data from the Italian Pediatric Rare Tumor Registry (TREP) was performed. Short-term (<30 days) and long-term complications of different surgical resections, as well as long-term follow-up were evaluated...
October 26, 2018: Pediatric Blood & Cancer
Shoji Kawakatsu, Yosuke Inoue, Yoshihiro Mise, Takeaki Ishizawa, Hiromichi Ito, Yu Takahashi, Akio Saiura
BACKGROUND: Postoperative pancreatic fistula (PF) is the main cause of operative mortality in patients who undergo pancreatoduodenectomy. Various pancreatoenteric anastomosis techniques have been reported to minimize the postoperative PF rate. However, the optimal method remains unknown. This study was performed to clarify the impact of pancreatojejunostomy on clinically relevant PF (CR-PF) between Blumgart anastomosis and Kakita anastomosis in patients with a soft pancreas. METHODS: In total, 620 consecutive patients underwent pancreatoduodenectomy at our institute from January 2010 to December 2016, and 282 patients with a soft pancreas were analyzed (Blumgart anastomosis, n = 110; Kakita anastomosis, n = 176)...
October 24, 2018: BMC Surgery
Feng Yang, Chen Jin, Ji Li, Yang Di, Jing Zhang, Deliang Fu
BACKGROUND: The mechanism of infected postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD) is undefined. Drain amylase has been used to predict POPF, whereas little data are available about the value of drain fluid culture. The aim was to investigate the incidence, risk factors and association with surgical outcomes of positive drainage culture (PDC) after PD. METHODS: A single-center retrospective analysis was conducted of prospectively collected data from patients who underwent PD between January 2005 and December 2015...
October 16, 2018: Journal of Hepato-biliary-pancreatic Sciences
Felix J Hüttner, Pascal Probst, Hannes G Kenngott, Phillip Knebel, Thilo Hackert, Alexis Ulrich, Markus W Büchler, Markus K Diener
BACKGROUND: Postoperative pancreatic fistula (POPF) remains a frequent problem especially after distal pancreatectomy. The application of 2-octyl cyanoacrylate showed promising results in the reduction of POPF after pancreatoduodenectomy prompting an expansion of this technique to distal pancreatectomy. Thus, the objective of the current study was to assess safety, feasibility and preliminary efficacy of an intraoperative 2-octyl cyanoacrylate application after distal pancreatectomy. METHODS: Between April 2015 and June 2016 adult patients scheduled for elective distal pancreatectomy were considered eligible for the study...
2018: PloS One
Jian Song, Zhigang He, Sunqiang Ma, Cheng Ma, Tianyu Yu, Jiyu Li
OBJECTIVES: Spleen-preserving distal pancreatectomy with splenic vessel preservation (SVP) and only the save of short gastric and left gastroepiploic vessels called the Warshaw technique (WT) are the optimal procedures to resect benign or borderline malignant tumors of the left pancreas. The aim of this meta-analysis was to assess the intra- and postoperative outcomes between SVP and the WT. METHODS: We searched studies that compared the intra- and postoperative outcomes between SVP and the WT from PubMed, Embase, and the Cochrane Library (2004-2017)...
October 12, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Eun Young Kim, Tae Ho Hong
Purpose: A soft texture of the pancreas is one of the most important predisposing factors for a pancreatic fistula. Thus, in a porcine model, we investigated a method to harden the pancreas locally by directly injecting an artificial material. Methods: During the laparotomy, 51 samples from 17 pigs, including 13 survival models, were randomly divided into 3 groups and either received a direct injection into the pancreas of MHL (1:4 mixture of histoacryl [n-butyl cyanoacrylate] and lipiodol) (group E) or saline (group C) or only received a pinprick into the pancreas without injecting a substance (sham)...
October 2018: Annals of Surgical Treatment and Research
Savio G Barreto, Ilse Dirkzwager, John A Windsor, Sanjay Pandanaboyana
BACKGROUND: Post-operative pancreatic fistulae (POPF) remain a major contributor to morbidity and mortality following pancreatic resection. Evidence for preoperative prediction of POPF based on cross-sectional imaging has not been systemically reviewed. This review aimed to determine whether preoperative imaging modalities can accurately predict the development of POPF. METHODS: A systematic review of major reference databases was undertaken, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, up to May 2018...
October 10, 2018: ANZ Journal of Surgery
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
Taiga Wakabayashi, Emanuele Felli, Patrick Pessaux
INTRODUCTION: Some articles have recently shown that robotic pancreaticoduodenectomy (PD) is feasible and can be a safe method. On the other hand, pancreatic fistulas (PF) remain the most dreaded complication after PD, and a secured pancreaticoenteric reconstruction may be essential in this regard. Previous articles have highlighted the usefulness of telescoped pancreaticogastrostomy (PG) in open PD to reduce the risk of postoperative PF. Additionally, in 2016, Addeo et al. described a double purse-string telescoped PG (DPS-PG), simplified from previous techniques, with favorable short-term results...
September 25, 2018: World Journal of Surgery
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