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fistula pancreas

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...
July 12, 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
Crystal B Chen, Neal S McCall, Michael J Pucci, Benjamin Leiby, Nooreen Dabbish, Jordan M Winter, Charles J Yeo, Harish Lavu
Postoperative pancreatic fistula (PF) remains one of the most significant complications after pancreaticoduodenectomy (PD). Recently, studies have suggested that post-PD serum hyperamylasemia (HA) may be a risk factor. In this study, we evaluate the relationship of pancreas texture and post-operative serum amylase levels in determining PF risk. This retrospective cohort study evaluated all patients who underwent PD at Thomas Jefferson University from 2009 to 2014. The highest postoperative serum amylase level from postoperative day (POD) 0 to POD 5 was obtained...
June 1, 2018: American Surgeon
Bobo Zheng, Nan Wang, Tao Wu, Qing Qiao, Li Gong, Shuai Zhou, Bo Zhang, Ying Yang, Ke Wang, Yulong Zhai, Xianli He
OBJECTIVE: To investigate the application value of the clearance of No.253 lymph nodes with priority to fascial space and preserving left colic artery (LCA) in patients undergoing laparoscopic radical proctectomy. METHODS: From August 2015 to August 2016, 97 consecutive middle-low rectal cancer patients underwent laparoscopic radical proctectomy using the clearance of No.253 lymph nodes with priority to fascial space and preserving LCA at Department of General Surgery, Tangdu Hospital...
June 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Jie Yin, Zipeng Lu, Pengfei Wu, Junli Wu, Wentao Gao, Jishu Wei, Feng Guo, Jianmin Chen, Kuirong Jiang, Yi Miao
OBJECTIVES: Postoperative pancreatic fistula (POPF) is a major complication and main cause of mortality after pancreaticoduodenectomy (PD). Afferent loop decompression technique (ALDT) has theoretical feasibility to reduce the rate of POPF. The aim of this study is to determine whether ALDT is a protective factor for POPF. METHODS: A total of 492 consecutive patients who underwent PD between January 2012 and December 2014 were identified from a prospective database...
July 2, 2018: World Journal of Surgery
Wu Seong Kang, Yun Chul Park, Young Goun Jo, Jung Chul Kim
Purpose: Pancreatic trauma is infrequent because of its central, deep anatomical position. This contributes to a lack of surgeon experience and many debates exist about its standard care. This study aimed to investigate the postoperative pancreatic fistula (POPF) and mortality of pancreatic trauma after operation. Methods: We reviewed records in the trauma registry of our institution submitted from January 2006 to December 2016. The grade of pancreatic injury, surgical management, morbidity, mortality, and other clinical variables included in the analyses...
July 2018: Annals of Surgical Treatment and Research
Wei Zhang, Sirong He, Yao Cheng, Jie Xia, Mingliang Lai, Nansheng Cheng, Zuojin Liu
BACKGROUND: The use of surgical drains has been considered mandatory after pancreatic surgery. The role of prophylactic abdominal drainage to reduce postoperative complications after pancreatic surgery is controversial. OBJECTIVES: To assess the benefits and harms of routine abdominal drainage after pancreatic surgery, compare the effects of different types of surgical drains, and evaluate the optimal time for drain removal. SEARCH METHODS: For the last version of this review, we searched CENTRAL (2016, Issue 8), and MEDLINE, Embase, Science Citation Index Expanded, and Chinese Biomedical Literature Database (CBM) to 28 August 2016)...
June 21, 2018: Cochrane Database of Systematic Reviews
Akira Mitsuyoshi, Shinshichi Hamada, Hidenori Ohe, Haruku Fujita, Hiroshi Okabe, Kenta Inoguchi
BACKGROUND: To prevent leakage of pancreatic juice from the main pancreatic duct (MPD), complete external drainage appears to be the most effective technique. However, because this requires a pancreatic stent tube to be ligated with MPD, duct-to-mucosa pancreaticojejunostomy (PJ) is difficult. From our histopathological examination, a large amount of pancreatic juice is drained from the ducts other than MPD. This study aimed to evaluate our new conceptual technique of PJ after pancreaticoduodenectomy (PD)...
June 19, 2018: World Journal of Surgery
O Ozsay, F Gungor, Serkan Karaisli, Ibrahim Kokulu, Osman Nuri Dilek
Hydatid cyst of the pancreas is a rarely seen entity even in endemic countries. Cyst may causes several symptoms due to external compression or fistulisation to pancreaticobiliary tract or small bowel. A 23-year-old female patient was referred with a complaint of abdominal pain. Preoperative imaging revealed an undefined cyst in the tail of pancreas. She underwent distal pancreatectomy and splenectomy, with a diagnosis of acute pancreatitis due to cystopancreatic duct fistula and also left-sided portal hypertension due to splenic vein thrombosis...
June 18, 2018: Annals of the Royal College of Surgeons of England
Seoung Yoon Rho, Sung Hyun Kim, Chang Moo Kang, Woo Jung Lee
Laparoscopic pancreaticoduodenectomy (PD) has been reported to be technically feasible and safe. Successful pancreatico-enteric anastomosis in particular is important for safe PD. Intraoperative perfusion of the remnant pancreas can be evaluated with ICG technology and be applied in pancreatic reconstruction in PD. A 68-year old female patient with distal common bile duct cancer underwent laparoscopic pylorus-preserving pancreaticoduodenectomy. After pancreaticojejunostomy (PJ), we checked perfusion of the anastomosis line using an ICG imaging system and noticed a perfusion defect at the anterior wall...
June 5, 2018: Minimally Invasive Therapy & Allied Technologies: MITAT
Sohei Satoi, Tomohisa Yamamoto, Fuyuhiko Motoi, Ippei Matsumoto, Hideyuki Yoshitomi, Ryosuke Amano, Munenori Tahara, Yoshiaki Murakami, Hidehito Arimitsu, Seiko Hirono, Masayuki Sho, Hironori Ryota, Masayuki Ohtsuka, Michiaki Unno, Yoshifumi Takeyama, Hiroki Yamaue
Background and Aim: Institutional standardization in the perioperative management of distal pancreatectomy (DP) has not been evaluated in a multicenter setting. The aim of the present study was to assess the influence of institutional standardization on the development of postoperative complications after DP. Methods: Data were collected from 1515 patients who underwent DP in 2006, 2010, and 2014 at 53 institutions in Japan. A standardized institution (SI) was defined as one that implemented ≥6 of 11 quality initiatives according to departmental policy...
May 2018: Annals of gastroenterological surgery
Andreas Minh Luu, Theodor Lutz, Waldemar Uhl, Chris Braumann
BACKGROUND: A 68-year-old asymptomatic patient was incidentally diagnosed with an intraductal papillary mucinous neoplasia (IPMN) of the pancreas with a pancreaticogastric fistula. He had a history of a right sided nephrectomy due to a renal cell carcinoma 9 years before. The patient underwent an uneventful total pancreatectomy and wedge resection of the stomach. METHODS: The patient's medical history was studied and compared to recent literature via PubMed. RESULTS: Pathohistological evaluation confirmed a mixed type IPMN of an intestinal subtype with pancreaticogastric fistula...
May 29, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Dilmurodjon Eshmuminov, Marcel A Schneider, Christoph Tschuor, Dimitri A Raptis, Patryk Kambakamba, Xavier Muller, Mickaël Lesurtel, Pierre-Alain Clavien
BACKGROUND: In 2016, the International Study Group of Pancreatic Fistula (ISGPS) proposed an updated definition for postoperative pancreatic fistula (POPF). Pancreas texture (PT) is an established risk factor of POPF. The definition of soft vs. hard texture, however, remains elusive. METHODS: A systematic search was performed to identify PT definitions and a meta-analysis linking POPF to PT using the updated ISGPS definition. RESULTS: 122 studies including 22 376 patients were identified...
May 25, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Baskaran Dhanapal, Gomathi Shankar, Balamourougan Krishnaraj, Ramkumar Govindarajalou, Jigish Ruparelia, Aniruthan Deivasigamani, Sarath Chandra Sistla
Portal annular pancreas is a rare congenital anomaly in which the portal vein and/or the splenoportal confluence are completely encircled by aberrant pancreatic parenchyma. It is an asymptomatic condition and is usually an incidental finding. It is, however, important to a surgeon because the postoperative pancreatic fistula (POPF) rates following pancreatic resection are higher in patients with this anomaly. A 47-year-old male presented with features of obstructive jaundice. He was diagnosed to have periampullary carcinoma, and pancreatoduodenectomy was planned...
March 26, 2018: Curēus
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