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postpancreatectomy hemorrhage

N Dusch, A Lietzmann, F Barthels, M Niedergethmann, F Rückert, T J Wilhelm
INTRODUCTION: The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity. METHODS: Between 2004 and 2014, 769 patients underwent resection...
April 1, 2017: Scandinavian Journal of Surgery: SJS
Sebastian Vâlcea, Mircea Beuran, Mihaela Vartic
Background: One of the most significant complications following pancreaticoduodenectomy is represented by postoperative hemorrhage. AIM: This study undertook an analysis of the cases that presented intraluminal bleeding of mechanical gastrojejunal anastomosis following pancreatico duodenectomy (PD) in the last five years. Methods: From January 2012 until January 2017, 84 consecutive pancreaticoduodenectomies were performed and managed by the same surgical team. The preferred procedure of reconstruction was Whipple (76 patients)...
January 2017: Chirurgia
Fritz Klein, Igor Maximilian Sauer, Johann Pratschke, Marcus Bahra
Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity...
2017: HPB Surgery: a World Journal of Hepatic, Pancreatic and Biliary Surgery
Xianbin Zhang, Xin Dong, Peng Liu, Yumei Yan, Yushan Wei, Dietmar Zechner, Peng Gong, Brigitte Vollmar
BACKGROUND: The aim of this study was to compare the safety and efficacy of a new technology, binding pancreaticojejunostomy (BPJ), with conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy in preventing postoperative pancreatic fistula (POPF). METHODS: Randomized controlled trials and observational studies were retrieved from literature searches. Pooled OR with 95% CI for dichotomous variables and weighted mean difference with 95% CI for continuous variables were calculated...
January 18, 2017: Digestive Surgery
Feng Gao, Jianguo Li, Shengwei Quan, Fujun Li, Donglai Ma, Lei Yao, Ping Zhang
The study aimed to investigate the risk factors of postpancreatectomy hemorrhage (PPH) after pancreaticoduodenectomy (PD). A retrospective analysis of 423 patients who underwent PD between January 2008 and January 2014 was conducted. The overall incidence and all-cause mortality of PPH were 9.9% (42/423) and 2.1% (9/423), respectively. Independent risk factors of early PPH were revascularization (odds ratio (OR) = 6.786; 95% confidence interval (95% CI): 1.785-25.792; P = 0.005), history of abdominal surgery (OR = 5...
2016: BioMed Research International
Giuseppe Malleo, Charles M Vollmer
Although mortality rates after pancreatectomy have decreased, the incidence of postoperative morbidity remains high. The major procedure-related complications are pancreatic fistula, delayed gastric emptying, and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery defined leading complications in a standardized fashion, allowing unbiased comparison of operative results and management strategies. Risk factors for postoperative complications have been investigated and quantitative scoring systems established to estimate patient-specific risks...
December 2016: Surgical Clinics of North America
C Gaudon, J Soussan, G Louis, V Moutardier, E Gregoire, V Vidal
PURPOSE: The objective of this study was to evaluate the effectiveness of endovascular treatment in patients presenting with late hemorrhage after pancreatectomy (LPPH). MATERIAL AND METHOD: Between 2008 and 2012, 53 percutaneous arterial procedures were performed in 42 patients with LPPH. There were 27 men and 15 women (mean age, 61.8 years±14.5 [SD]; range: 19-81 years). Clinical and technical success along with frequency of complications associated with the use of different endovascular techniques in patients with and without arterial anatomical variation were assessed...
November 2016: Diagnostic and Interventional Imaging
J Perinel, G Nappo, M El Bechwaty, T Walter, V Hervieu, P J Valette, P Feugier, M Adham
Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria. MATERIAL AND METHODS: All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients)...
December 2016: Langenbeck's Archives of Surgery
Nicole Hassold, Franziska Wolfschmidt, Alexander Dierks, Ingo Klein, Thorsten Bley, Ralph Kickuth
OBJECTIVE: The purpose of this study was to evaluate the clinical and long-term outcome of patients who underwent covered stent treatment because of late-onset postpancreatectomy hemorrhage in a greater number of patients. A secondary study goal was to compare embolization techniques with covered stents regarding differences in early and late clinical outcome, rebleeding, and vessel patency. METHODS: Between December 2008 and June 2015, 27 consecutive patients suffering from major hemorrhage after pancreatic surgery underwent either covered stent placement or embolization of the affected visceral artery...
July 22, 2016: Journal of Vascular Surgery
Matias Laaninen, Juhani Sand, Isto Nordback, Kaija Vasama, Johanna Laukkarinen
OBJECTIVES: The aim of this study was to study whether post-pancreaticoduodenectomy complications (PPDC) in high-risk patients can be reduced with hydrocortisone. BACKGROUND: Soft pancreas is a well-known risk factor for PPDC. Previously, we have shown that patients with >40% acini in the pancreatic transection line are most prone to PPDC. Recent studies have demonstrated that surgical trauma leads to inflammation of the pancreatic remnant, which precedes PPDC...
November 2016: Annals of Surgery
Daniel Ansari, Linus Aronsson, Joakim Fredriksson, Bodil Andersson, Roland Andersson
BACKGROUND: The safety of pancreatic resection for elderly patients is still controversial. We examined the postoperative morbidity and mortality in patients aged 75 years or more undergoing pancreatic resection. METHODS: Patients undergoing pancreatic resection were studied retrospectively and the outcomes were compared between patients aged <75 and ≥75 years. RESULTS: Of the 556 patients enrolled, 78 (14%) were ≥75 years old. Elderly patients had significantly more co-morbidities, especially cardiovascular pathology (P=0...
April 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Yonghua Chen, Singming Xie, Xubao Liu, Gang Mai
The purpose of this study was to evaluate the utility of the nonabsorbable polymer ligating clips during open pancreaticoduodenectomy. Ninety-eight consecutive patients underwent open pancreaticoduodenectomy using either the polymer clip (hem-o-lock R) system for gastroduodenal artery and right gastric artery control or conventional knot tying (n = 151) for these artery control. The two groups were similar regarding demographic data, preoperative/intraoperative characteristic, pathologic findings, anastomotic leakage, and intraperitoneal collections or abscess...
December 2015: Indian Journal of Surgery
Sadaki Asari, Ippei Matsumoto, Hirochika Toyama, Masato Yamaguchi, Takuya Okada, Makoto Shinzeki, Tadahiro Goto, Tetsuo Ajiki, Takumi Fukumoto, Yonson Ku
BACKGROUND: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication of pancreatic surgery. The shift from surgical to radiological intervention was recently reported in retrospective cohort studies, but it has remained controversial as to which emergent intervention provides optimal management. METHODS: All 553 patients who underwent standard pancreatic resection at Kobe University Hospital between January 2003 and December 2013 were included. Patient data and complication data were identified from a prospective database...
May 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
D Ansari, B Tingstedt, G Lindell, I Keussen, D Ansari, R Andersson
BACKGROUND AND AIMS: Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. MATERIALS AND METHODS: A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria...
March 2017: Scandinavian Journal of Surgery: SJS
Kevin C Ching, Ernesto Santos, Kevin M McCluskey, Phillip D Orons, Rupal Bandi, Christopher J Friend, Minzhi Xing, Amer H Zureikat, Herbert J Zeh
PURPOSE: To evaluate the efficacy and clinical outcomes associated with stent-graft placement and coil embolization for postpancreatectomy arterial hemorrhage (PPAH). MATERIALS AND METHODS: Retrospective review of 38 stent-graft and/or embolization procedures in 28 patients (23 men; mean age, 65.1 y) for PPAH between 2007 and 2014 was performed. Time of bleeding, source of hemorrhage, intervention and devices used, repeat intervention rate, time to recurrent bleeding, complications, and 30-day mortality were assessed...
January 2016: Journal of Vascular and Interventional Radiology: JVIR
Kazuhito Mita, Hideto Ito, Koudai Takahashi, Masatoshi Hashimoto, Kiichi Nagayasu, Ryo Murabayashi, Hideki Asakawa, Kazuya Koizumi, Takashi Hayashi, Keiichi Fujino
Background Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Methods Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations...
June 2016: Surgical Innovation
Giorgio Romano, Antonino Agrusa, Massimo Galia, Giuseppe Di Buono, Daniela Chianetta, Vincenzo Sorce, Leonardo Gulotta, Giuseppe Brancatelli, Gaspare Gulotta
INTRODUCTION: Pancreatic cancer is the fourth cause of death from cancer in Western countries. The radical surgical resection is the only curative option for this pathology. The prevalence of this disease increases with age in population. The causes of pancreatic cancer are unknown, but we consider risk factors like smoke and tobacco usage, alcohol consumption coffee, history of diabetes or chronic pancreatitis. In this study we report our experience in the treatment of resectable pancreatic cancer and periampullary neoplasms with particular attention to evaluate the evolution of surgical technique and the clinical postoperative outcomes...
September 2015: International Journal of Surgery
Chun-Lu Tan, Hao Zhang, Bing Peng, Ke-Zhou Li
AIM: To compare laparoscopic pancreaticoduodenectomy (TLPD) during the initial learning curve with open pancreaticoduodenectomy in terms of outcome and costs. METHODS: This is a retrospective review of the consecutive patients who underwent TLPD between December 2009 and April 2014 at our institution. The experiences of the initial 15 consecutive TLPD cases, considered as the initial learning curve of each surgeon, were compared with the same number of consecutive laparotomy cases with the same spectrum of diseases in terms of outcome and costs...
May 7, 2015: World Journal of Gastroenterology: WJG
Salvatore Buscemi, Giuseppe Damiano, Vincenzo D Palumbo, Gabriele Spinelli, Silvia Ficarella, Giulia Lo Monte, Antonio Marrazzo, Attilio I Lo Monte
Pancreaticoduodenectomy (PD) is considered the gold standard treatment for periampullory carcinomas. This procedure presents 30%-40% of morbidity. Patients who have undergone pancreaticoduodenectomy often present perioperative malnutrition that is worse in the early postoperative days, affects the process of healing, the intestinal barrier function and the number of postoperative complications. Few studies focus on the relation between enteral nutrition (EN) and postoperative complications. Our aim was to perform a review, including only randomized controlled trial meta-analyses or well-designed studies, of evidence regarding the correlation between EN and main complications and outcomes after pancreaticoduodenectomy, as delayed gastric emptying (DGE), postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), length of stay and infectious complications...
May 2015: Nutrients
Bhavraj S Khalsa, David K Imagawa, Joseph I Chen, Aram N Dermirjian, Douglas B Yim, Laura K Findeiss
OBJECTIVES: We summarized a single center's evolution in the management of postpancreatectomy hemorrhage (PPH) from surgical toward endovascular management. METHODS: Between 2003 and 2013, 337 patients underwent Whipple procedures. Using the International Study Group of Pancreatic Surgery (ISGPS) consensus definition, patients with PPH were identified and retrospectively analyzed for the presentation of hemorrhage, type of intervention, and 90-day mortality outcome measures...
August 2015: Pancreas
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