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J A Milburn, J A Bailey, Wk Dunn, I C Cameron, D S Gomez
INTRODUCTION Magnetic resonance cholangiopancreatography (MRCP) is commonly used to evaluate the biliary tree, although indications for patients who require inpatient imaging are not fully defined. The aim of this study was to evaluate inpatient MRCP performed on surgical patients and to devise a treatment pathway for these patients. MATERIAL AND METHODS All adult inpatient MRCP examinations between January 2012 and December 2013 were reviewed. Demographic, clinical and radiological data were collated. RESULTS During the study period, 271 inpatient MRCP were requested, of which 234 examinations were included...
September 23, 2016: Annals of the Royal College of Surgeons of England
F Rauchfuß, U Settmacher
No abstract text is available yet for this article.
September 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Ahmed Mahmoud Hamza, Emad Helmi Ayyash, Raed Alzafiri, Issam Francis, Sami Asfar
Gastrointestinal stromal tumours (GISTs) are solid tumours of the gastrointestinal tract, mostly found in the stomach and intestine. They rarely present as cystic lesions. A 74-year-old woman referred to the hepatopancreaticobiliary unit, with 3 months history of upper abdominal discomfort. Abdominal ultrasound scan showed a large cystic lesion in the epigastric region suggestive of a pancreatic pseudocyst. The CT-scan showed a 6.6×6×6.3 cm size cyst related to the pancreas and extending to the hepatogastric omentum...
2016: BMJ Case Reports
Puraj P Patel, Michael W Love, Joseph A Ewing, Jeremy A Warren, William S Cobb, Alfredo M Carbonell
INTRODUCTION: Laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh placement is well established; however, the fate of patients requiring future abdominal operations is not well understood. This study identifies the characteristics of LVHR patients undergoing reoperation and the sequelae of reoperation. METHODS: A retrospective review of a prospectively maintained database at a hernia referral center identified patients who underwent LVHR between 2005 and 2014 and then underwent a subsequent abdominal operation...
June 23, 2016: Surgical Endoscopy
Y Kim, F Bagante, F Gani, A Ejaz, L Xu, J O Wasey, D J Johnson, S M Frank, T M Pawlik
BACKGROUND: Predictive tools assessing risk of transfusion have not been evaluated extensively among patients undergoing complex gastrointestinal surgery. In this study preoperative variables associated with blood transfusion were incorporated into a nomogram to predict transfusion following hepatopancreaticobiliary (HPB) or colorectal surgery. METHODS: A nomogram to predict receipt of perioperative transfusion was developed using a cohort of patients who underwent HPB or colorectal surgery between January 2009 and December 2014...
August 2016: British Journal of Surgery
Alexander S Rosemurgy, Carrie E Ryan, Richard L Klein, Thomas W Wood, Franka Co, Sharona B Ross
Financial implications of developing a hepatopancreaticobiliary (HPB) center have not been considered. We undertook this study to determine hospital income associated with a new HPB center and to gauge the opportunity cost associated with such a center. Operations included were based on the HPB fellowship curriculum and the six most commonly undertaken general surgery operations. The income with "core" HPB operations (n = 93) and the six most frequently undertaken general surgery operations (n = 583) at one hospital from June 2012 to June 2013 were determined...
May 2016: American Surgeon
Erdem Kinaci, Mert Mahsuni Sevinc, Savas Bayrak, Emre Erdoğan, Abdulkerim Ozakay, Serkan Sari
INTRODUCTION: The Classification of Intraoperative Complications (CLASSIC) is one of two recent classification systems for intraoperative adverse events (iAEs), featuring simple but inclusive definitions. No data have been reported regarding the relation between CLASSIC and postoperative course. The aim of the present study was to evaluate the relation between the grade of iAEs and the grade of postoperative complications in patients who underwent hepatopancreaticobiliary (HPB) surgery...
May 2016: International Journal of Surgery
Hiroshi Sekiguchi, Ryohei Horie, Mio Kanai, Reina Suzuki, Eunhee S Yi, Jay H Ryu
OBJECTIVE: To investigate clinical and pathologic aspects of IgG4-related disease (IgG4-RD) in non-Asian populations. METHODS: We conducted a retrospective review of the medical records of patients with IgG4-RD who presented to an academic medical center from January 1994 to September 2012. RESULTS: Among 166 patients identified, the median age at diagnosis was 61 years (interquartile range [IQR] 49-70 years), 75% were male, and 80% were white...
September 2016: Arthritis & Rheumatology
D Rohan Jeyarajah, Russell S Berman, Majella Doyle, Sunil K Geevarghese, Mitchell C Posner, Douglas Farmer, Rebecca M Minter
The findings and recommendations of the North American Consensus Conference on Training in HPB Surgery held October 2014 are presented. The conference was hosted by the Society for Surgical Oncology (SSO), Americas Hepatopancreaticobiliary Association (AHPBA), and the American Society of Transplant Surgeons (ASTS). The current state of training in HPB surgery in North America was defined through three pathways-HPB, Surgical Oncology, and Solid Organ Transplant fellowships. Consensus regarding programmatic requirements included establishment of minimum case volumes and inclusion of quality metrics...
July 2016: Annals of Surgical Oncology
D R Jeyarajah, R S Berman, M B Doyle, S K Geevarghese, M C Posner, D Farmer, R M Minter
The findings and recommendations of the North American consensus conference on training in hepatopancreaticobiliary (HPB) surgery held in October 2014 are presented. The conference was hosted by the Society for Surgical Oncology (SSO), the Americas Hepato-Pancreatico-Biliary Association (AHPBA), and the American Society of Transplant Surgeons (ASTS). The current state of training in HPB surgery in North America was defined through three pathways-HPB, surgical oncology, and solid organ transplant fellowships...
April 2016: American Journal of Transplantation
Sean M Ronnekleiv-Kelly, Kevin C Soares, Aslam Ejaz, Timothy M Pawlik
PURPOSE OF REVIEW: Historically, surgical treatment of choledochal cyst consisted of cyst enterostomy. However, incomplete cyst excision can result in recurrent symptoms and malignant transformation within the cyst remnant. Accordingly, management of choledochal cyst now includes complete cyst excision whenever possible. We provide a review detailing the up to date management of choledochal cysts. We describe choledochal cyst-type specific surgical approaches, the impact of minimally invasive surgery in choledochal cyst therapy, and long-term sequelae of choledochal cyst management...
May 2016: Current Opinion in Gastroenterology
Donna Marie L Alvino, David C Chang, Zhi Ven Fong
Randomized controlled trials have historically been regarded as the gold standard of modern clinical research tools, allowing us to elucidate the efficacy of novel therapeutics in an unparalleled manner. However, when attempting to generalize trial results to broader populations, it becomes apparent that the unexplained outcome variability exists among treatment recipients, suggesting that randomized controlled trials harbor inherent limitations. Herein, we explore the benefits of health services (outcomes) research utilization in addressing variation in patient outcomes following surgical intervention in the non-randomized setting, with a specific focus on hepatopancreaticobiliary surgery outcomes...
April 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Jennifer Straatman, Miguel A Cuesta, Elly S M de Lange-de Klerk, Donald L van der Peet
INTRODUCTION: Postoperative complications have been associated with decreased long-term survival in cardiac, orthopedic, and vascular surgery. For major abdominal surgery research, conflicting evidence is reported in smaller studies. The aim of this study was to assess the effect of complications on long-term survival in major abdominal surgery. MATERIAL AND METHODS: An observational cohort study was conducted of 861 consecutive patients that underwent major abdominal surgery between January 2009 and March 2014, with prospective assessment of the survival status...
May 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Hwai-Ding Lam, Aude Vanlander, Frederik Berrevoet
AIM: We retrospectively analyzed incisional hernia (IH) outcomes of liver transplant (LT) vs. hepatopancreaticobiliary (HPB) cases sharing the same incision. METHODS: IH repair patients with a history of LT were compared with those with HPB surgical history sharing the same type of incision and using the European Hernia Society classification and nomenclature for reporting outcome. RESULTS: Eighty-two patients (27 HPB and 55 LT) between February 2001 and February 2014 were analyzed...
March 2016: Clinical Transplantation
George Bouras, Sheraz R Markar, Elaine M Burns, Hugh A Mackenzie, Alex Bottle, Thanos Athanasiou, George B Hanna, Ara Darzi
OBJECTIVE: To evaluate risk of psychiatric morbidity and its impact on survival in gastrointestinal surgery. BACKGROUND: Psychiatric morbidity related to surgery is poorly understood, and may be evaluated using linked hospital and primary care data. METHODS: Patients undergoing gastrointestinal surgery from 2000 to 2011 with linkage of Clinical Practice Research Datalink (CPRD), Hospital Episodes Statistics (HES), Office of National Statistics (ONS), and National Cancer Intelligence Network (NCIN) databases were studied...
July 2016: Annals of Surgery
D Wagner, S Büttner, Y Kim, F Gani, L Xu, G A Margonis, N Amini, I R Kamel, T M Pawlik
BACKGROUND: Although frailty is a known determinant of poor postoperative outcomes, it can be difficult to identify in patients before surgery. The authors sought to develop a preoperative frailty risk model to predict mortality among patients aged 65 years or more. METHODS: Clinical and morphometric data including total psoas area (TPA), total psoas volume (TPV) and psoas density (Hounsfield unit average calculation, HUAC) were collected for patients undergoing hepatopancreaticobiliary (HPB) surgery between 2012 and 2014...
January 2016: British Journal of Surgery
Howard Nelson-Williams, Faiz Gani, Arman Kilic, Gaya Spolverato, Yuhree Kim, Doris Wagner, Neda Amini, Aslam Ejaz, Timothy M Pawlik
IMPORTANCE: In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending. OBJECTIVE: To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in the United States. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of total costs among 42 480 patients undergoing hepatopancreaticobiliary surgery from January 1, 2002, through December 31, 2011, using a nationally representative data set (Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project)...
February 2016: JAMA Surgery
Marc Niebel, M Thamara P R Perera, Tahir Shah, Ravi Marudanayagam, Kate Martin, Beryl A Oppenheim, Miruna D David
Enterococcal infections are common in liver transplantation and hepatopancreaticobiliary (HPB) surgery. Linezolid is frequently used to treat not only vancomycin-resistant Enterococcus (VRE), but also vancomycin-sensitive Enterococcus (VSE) infections, and resistance can develop. This study evaluated all the Liver Unit patients who developed infections with linezolid-resistant Enterococcus (LRE) in order to elicit the association with prior linezolid usage, to explore possible risk factors for infection, and to better understand the epidemiology of these isolates in this patient group...
February 2016: Liver Transplantation
Gregory Larrieux, Blake I Wachi, John T Miura, Kiran K Turaga, Kathleen K Christians, T Clark Gamblin, Wendy L Peltier, David E Weissman, Ann B Nattinger, Fabian M Johnston
BACKGROUND: Despite previous literature affirming the importance of palliative care training in surgery, there is scarce literature about the readiness of Surgical Oncology and hepatopancreaticobiliary (HPB) fellows to provide such care. We performed the first nationally representative study of surgical fellowship program directors' assessment of palliative care education. The aim was to capture attitudes about the perception of palliative care and disparity between technical/clinical education and palliative care training...
December 2015: Annals of Surgical Oncology
Sarah C Thomasset, David Saunders, Adele Holland, Ashley R Dennison, Giuseppe Garcea
BACKGROUND: To date, no studies have sought to determine the frequency of malignancy in patients presenting with a putative biliary stricture and normal liver function tests (LFTs). The primary aim of this retrospective cohort study was to determine the likelihood of malignancy in patients presenting with a biliary stricture and normal LFTs, a normal bilirubin level either alone or in combination with normal levels of liver enzymes [alkaline phosphatase (ALP) and alanine transaminase (ALT)]...
November 2015: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
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