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fistula pancreas

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
Takashi Harino, Yoshito Tomimaru, Kozo Noguchi, Hirotsugu Nagase, Takayuki Ogino, Masashi Hirota, Kazuteru Oshima, Tsukasa Tanida, Shingo Noura, Hiroshi Imamura, Takashi Iwazawa, Kenzo Akagi, Masashi Yamamoto, Tsutomu Nishida, Hiromi Tamura, Shiro Adachi, Keizo Dono
BACKGROUND: Intraductal papillary-mucinous neoplasms (IPMNs) are potentially malignant intraductal epithelial neoplasms that sometimes penetrate into other organs. To the best of our knowledge, no report has yet described a case with penetration into the spleen. We recently encountered a case of IPMN with penetration of the stomach and spleen that was successfully treated by total pancreatectomy. CASE PRESENTATION: A 70-year-old female visited our hospital with a complaint of fever and abdominal pain...
September 15, 2018: Surgical Case Reports
Gunjan Desai, Rajvilas Narkhede, Prasad Pande, Paresh Varty, Hitesh Mehta, Dattaprasanna Kulkarni
OBJECTIVE: This article aims to identify the patient selection criteria and approach in treating persistent external pancreatic fistulas surgically with Roux-en-Y fistulojejunostomy, and it evaluates the outcomes of Roux-en-Y fistulojejunostomy with a review of the relevant literature. MATERIAL AND METHODS: A retrospective data analysis from January 2010 to May 2017 revealed 6 patients who were managed with Roux-en-Y fistulojejunostomy for persistent external pancreatic fistulas, and their details were entered in a proforma...
August 28, 2018: Turkish Journal of Surgery
Ali Kord Valeshabad, Jennifer Acostamadiedo, Lekui Xiao, Winnie Mar, Karen L Xie
A 49-year-old male with history of chronic alcohol-induced pancreatitis presented with one month of worsening left pleuritic chest pain and shortness of breath. Chest radiograph demonstrated bilateral pleural effusions. Thoracentesis revealed increased amylase in the pleural fluid. Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a fistula tract between the left pleural cavity and pancreas which was confirmed on endoscopic retrograde cholangiopancreatography (ERCP). Patient was treated with placement of a pancreatic stent with complete resolution of the fistula tract approximately in 9 weeks...
2018: Case Reports in Gastrointestinal Medicine
Naokazu Chiba, Yuta Abe, Kei Yokozuka, Kosuke Hikita, Toshimichi Kobayashi, Toru Sano, Koichi Tomita, Rina Tsutsui, Shigeyuki Kawachi
BACKGROUND: The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula...
September 5, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Luca Morelli, Gregorio Di Franco, Simone Guadagni, Matteo Palmeri, Niccoló Furbetta, Niccola Funel, Desirée Gianardi, Andrea De Palma, Luca Pollina, Andrea Moglia, Andrea Pietrabissa, Giulio Di Candio, Franco Mosca, Alfred Cuschieri
Background: Cystic pancreatic lesions (CPLs) are being identified increasingly, and some benefit from surgical treatment. With the increasing use of robotic-assisted surgery (RAS) for neoplasms of the pancreas, the aim of the present comparative study is to establish whether the RAS offered any advantages over conventional open surgery (OS) in the management of CPLs. Patients and Methods: Twenty-seven out of 37 robot-assisted left-sided pancreatectomy (LSP) performed between January 2010 and April 2017 were carried out for CPLs...
September 3, 2018: Journal of Minimal Access Surgery
Zunxiang Ke, Jing Cui, Nianqi Hu, Zhiyong Yang, Hengyu Chen, Jin Hu, Chunyou Wang, Heshui Wu, Xiuquan Nie, Jiongxin Xiong
This study was designed to analyze the risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).Between September 2015 and August 2017, 170 successive patients underwent a radical PD in the Department of Pancreatic Surgery, Union Hospital, Wuhan. We carried out a retrospective study of these cases and the prospective conditions, which might be related to POPF, were examined with univariate and multivariate analysis. POPF was defined as a drain output of any measurable volume of fluid with an amylase level more than 3 times the upper limit of serum amylase activity on postoperative day 3, accompanied by a clinically relevant condition according to the 2016 update of the International Study Group for Pancreatic Surgery (ISGPS) definition...
August 2018: Medicine (Baltimore)
Ignasi Poves, Fernando Burdío, Olga Morató, Mar Iglesias, Aleksander Radosevic, Lucas Ilzarbe, Laura Visa, Luís Grande
OBJECTIVE: To compare perioperative outcomes of pancreatoduodenectomy (PD) performed through the laparoscopic route or by open surgery. SUMMARY BACKGROUND DATA: Laparoscopic PD is being progressively performed in selected patients. METHODS: An open-label single-center RCT was conducted between February 2013 and September 2017. The primary endpoint was the length of hospital stay (LOS). Secondary endpoints were operative time, transfusion requirements, specific pancreatic complications (pancreatic or biliary fistula, pancreatic hemorrhage, and delayed gastric emptying), Clavien-Dindo grade ≥ 3 complications, comprehensive complication index (CCI) score, poor quality outcome (PQO), and the quality of pathologic resection...
November 2018: Annals of Surgery
Woo Jung Lee
PURPOSE: Leakage of pancreatico-jejunal anastomosis (PJ) remains the primary cause of morbidity and mortality after Whipple's operation. To reduce the occurrence thereof, the present author recently began to apply a modification of the Blumgart method of anastomosis after Whipple's operation (hereinafter referred to as Lee's method), with very good results. MATERIALS AND METHODS: The modified method and technique utilizes fish-mouth closure of a beveled pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures (symmetric horizontal mattress-type sutures between the full thickness of the pancreas and the jejunal limb) after duct-to-mucosa pancreatico-jejunostomy...
September 2018: Yonsei Medical Journal
Thijs de Rooij, Jony van Hilst, Hjalmar van Santvoort, Djamila Boerma, Peter van den Boezem, Freek Daams, Ronald van Dam, Cees Dejong, Eino van Duyn, Marcel Dijkgraaf, Casper van Eijck, Sebastiaan Festen, Michael Gerhards, Bas Groot Koerkamp, Ignace de Hingh, Geert Kazemier, Joost Klaase, Ruben de Kleine, Cornelis van Laarhoven, Misha Luyer, Gijs Patijn, Pascal Steenvoorde, Mustafa Suker, Moh'd Abu Hilal, Olivier Busch, Marc Besselink
OBJECTIVE: This trial followed a structured nationwide training program in minimally invasive distal pancreatectomy (MIDP), according to the IDEAL framework for surgical innovation, and aimed to compare time to functional recovery after minimally invasive and open distal pancreatectomy (ODP). BACKGROUND: MIDP is increasingly used and may enhance postoperative recovery as compared with ODP, but randomized studies are lacking. METHODS: A multicenter patient-blinded randomized controlled superiority trial was performed in 14 centers between April 2015 and March 2017...
August 3, 2018: Annals of Surgery
Stefano Andrianello, Giovanni Marchegiani, Elisa Bannone, Gaia Masini, Giuseppe Malleo, Gabriele L Montemezzi, Enrico Polati, Claudio Bassi, Roberto Salvia
BACKGROUND: Recent studies have suggested that intraoperative fluid overload is associated with a worse outcome after major abdominal surgery. However, evidence in the field of pancreatic surgery is still not consistent. The aim of this study was to evaluate whether intraoperative fluid management could affect the outcome of a major pancreatic resection. METHODS: Prospective analysis of 350 major pancreatic resections performed in 2016 at the Department of General and Pancreatic Surgery-The Pancreas Institute, University of Verona Hospital Trust...
July 31, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Simone Conci, Andrea Ruzzenente, Francesca Bertuzzo, Tommaso Campagnaro, Alfredo Guglielmi, Calogero Iacono
BACKGROUND: Total dorsal pancreatectomy (TDP) is a conservative pancreatic resection that should be considered in cases of benign or low malignant tumors confined to the dorsal pancreas to preserve the viability of both digestive and biliary tracts, and to avoid the endocrine and metabolic consequences of total pancreatectomy. We report a new case of TDP and provide a literature review of this procedure. METHODS: The case reported was a 35-year-old female patient with a solid pseudopapillary tumor...
July 13, 2018: Digestive Surgery
Elisa Bannone, Stefano Andrianello, Giovanni Marchegiani, Gaia Masini, Giuseppe Malleo, Claudio Bassi, Roberto Salvia
OBJECTIVE: The aim of the study is to characterize postoperative acute pancreatitis (POAP). SUMMARY BACKGROUND DATA: A standardized definition of POAP after pancreaticoduodenectomy (PD) has been recently proposed, but specific studies are lacking. METHODS: The patients were extracted from the prospective database of The Pancreas Institute of Verona. POAP was defined as an elevation of the serum pancreatic amylase levels above the upper limit of normal (52 U/L) on postoperative day (POD) 0 or 1...
November 2018: Annals of Surgery
Suguru Yamada, Tsutomu Fujii, Manabu Kawai, Toshio Shimokawa, Masafumi Nakamura, Yoshiaki Murakami, Sohei Satoi, Hidetoshi Eguchi, Yuichi Nagakawa, Yasuhiro Kodera, Hiroki Yamaue
BACKGROUND: In distal pancreatectomy (DP), it is customary to ligate and divide the splenic vein after isolating it from the pancreatic parenchyma. This is considered essential to prevent disruption of the stump of the splenic vein and consequent intra-abdominal haemorrhage in the event of pancreatic fistula (PF). However, this procedure can be technically demanding, especially when the vein is firmly embedded in the pancreatic parenchyma. The objective of the COSMOS-DP trial is to confirm the non-inferiority of resection of the splenic vein embedded in the pancreatic parenchyma compared with the conventional technique of isolating the splenic vein before resection during DP using a mechanical stapler...
July 11, 2018: Trials
Satoshi Ida, Naoki Hiki, Takeaki Ishizawa, Yugo Kuriki, Mako Kamiya, Yasuteru Urano, Takuro Nakamura, Yasuo Tsuda, Yosuke Kano, Koshi Kumagai, Souya Nunobe, Manabu Ohashi, Takeshi Sano
Purpose: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model...
June 2018: Journal of Gastric Cancer
Adrian Bartos, Mihnea Ionescu, Cornel Iancu, Cezar Stroescu, Florin Zaharie, Vladislav Brasoveanu, Nadim Al Hajjar, Catalin Vasilescu, Florin Graur, Ionut Hutanu, Lucian Mocan, Leonard David, Raluca Bodea, Dan Cacovean, Geza Molnar, Luminita Furcea, Sorin Alexandrescu, Emil Matei, Gabriel Mitulescu, Constantin Ungureanu, Aurel Tonea, Radu Zamfir, Irinel Popescu, Traian Dumitrascu
Introduction: National databases for pancreaticoduodenectomies (PD) have contributed to better postoperative outcomes after such complex surgical procedure because the multicentre collection of data allowed more reliable analyses with quality assessment and further improvement of technical issues and perioperative management. The current practice and outcomes after PD are poorly known in Romania because there was no national database for these patients. Thus, in 2016 a national-intent electronic registry for PD was proposed for all Romanian surgical centers...
May 2018: Chirurgia
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