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https://www.readbyqxmd.com/read/28767125/eras-improving-outcome-in-the-cachectic-hpb-patient
#1
REVIEW
David P J van Dijk, Victor van Woerden, Hamit Cakir, Marcel den Dulk, Steven W M Olde Damink, Cornelis H C Dejong
The enhanced recovery after surgery (ERAS) program has reduced postoperative morbidity and duration of hospital stay but not mortality in patients undergoing hepatopancreatobiliary (HPB) surgery. Many HPB patients suffer from cancer cachexia, a syndrome of severe weight and muscle loss. This may affect outcomes of HPB surgery even within an ERAS program. A tailored ERAS approach may be essential in further improving outcome in this vulnerable patient category.
August 2, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28746153/a-randomized-controlled-trial-of-postoperative-thoracic-epidural-analgesia-versus-intravenous-patient-controlled-analgesia-after-major-hepatopancreatobiliary-surgery
#2
Thomas A Aloia, Bradford J Kim, Yun Shin Segraves-Chun, Juan P Cata, Mark J Truty, Qiuling Shi, Alexander Holmes, Jose M Soliz, Keyuri U Popat, Thomas F Rahlfs, Jeffrey E Lee, Xin Shelley Wang, Jeffrey S Morris, Vijaya N R Gottumukkala, Jean-Nicolas Vauthey
OBJECTIVES: The primary objective of this randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient-controlled analgesia (IV-PCA) for pain control over the first 48 hours after hepatopancreatobiliary (HPB) surgery. Secondary endpoints were patient-reported outcomes, total narcotic utilization, and complications. BACKGROUND: Although adequate postoperative pain control is critical to patient and surgeon success, the optimal analgesia regimen in HPB surgery remains controversial...
September 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28708769/a-national-survey-on-peri-interventional-management-of-percutaneous-transhepatic-biliary-drainage
#3
Chulja J Pek, Monique van Dijk, Bas Groot Koerkamp, Adriaan Moelker, Casper H J van Eijck
PURPOSE: The purpose of this study is to evaluate knowledge about management of percutaneous transhepatic biliary drainage (PTBD) catheters among nurses taking care of hepato-pancreato-biliary (HPB) patients. METHODS: Six HPB nurses from the Dutch national HPB association created a questionnaire that was complemented by 2 HPB surgeons, 3 HPB interventional radiologists, and a methodologist. Registered nurses working at the department of gastroenterology or gastrointestinal surgery and familiar with the care for HPB patients were invited to complete the questionnaire...
August 2017: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/28700780/distinction-of-risk-factors-for-superficial-vs-organ-space-surgical-site-infections-after-pancreatic-surgery
#4
Irmina A Elliott, Carmen Chan, Tara A Russell, Amanda M Dann, Jennifer L Williams, Lauren Damato, Hallie Chung, Mark D Girgis, O Joe Hines, Howard A Reber, Timothy R Donahue
Importance: Surgical site infection (SSI) rates are increasingly used as a quality metric. However, risk factors for SSI in pancreatic surgery remain undefined. Objective: To stratify superficial and organ-space SSIs after pancreatectomy and investigate their modifiable risk factors. Design, Setting, and Participants: This retrospective analysis included 201 patients undergoing pancreatic surgery at a university-based tertiary referral center from July 1, 2013, through June 30, 2015, and 10 371 patients from National Surgical Quality Improvement Program-Hepatopancreaticobiliary (NSQIP-HPB) Collaborative sites from January 1, 2014, through December 31, 2015...
July 12, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28698017/stepwise-introduction-of-laparoscopic-liver-surgery-validation-of-guideline-recommendations
#5
Marcel J van der Poel, Floor Huisman, Olivier R Busch, Mohammad Abu Hilal, Thomas M van Gulik, Pieter J Tanis, Marc G Besselink
BACKGROUND: Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction. METHODS: A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared...
July 8, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28696146/heat-resistance-of-histidine-decarboxylase-from-gram-negative-histamine-producing-bacteria-in-seafood
#6
K Bjornsdottir-Butler, F A Bencsath, S McCarthy, R A Benner
Precooking of tuna is a potential critical control point (CCP) in the commercial manufacturing of canned tuna. To assess the efficacy of precooking as a CCP, an understanding of the thermal properties of histamine-producing bacteria (HPB) and their histidine decarboxylase (HDC) enzymes is required. The thermal properties of many HPB have been determined, but the thermal resistances of the HDC enzymes are unknown. The purpose of this study was to determine the D- and z-values of selected HDC enzymes to evaluate the CCP of precooking during the canning process and provide scientific data to support U...
July 11, 2017: Journal of Food Protection
https://www.readbyqxmd.com/read/28643856/coding-in-surgery-impact-of-a-specialized-coding-proforma-in-hepato-pancreato-biliary-surgery
#7
Jennifer Murphy, Charlotte May, Sara Di Carlo, Ian Beckingham, Iain C Cameron, Dhanny Gomez
BACKGROUND: Coding inaccuracies in surgery misrepresent the productivity of hospitals and outcome data of surgeons. The aim of this study was to audit the extent of coding inaccuracies in hepato-pancreato-biliary (HPB) surgery and assess the financial impact of introducing a coding proforma. METHODS: Coding of patients who underwent elective HPB surgery over a 3-month period was audited. Codes were based on International Classification of Diseases 10 and Office of Population and Census Surveys-4 codes...
June 23, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28615138/wide-versus-narrow-margins-after-partial-hepatectomy-for-hepatocellular-carcinoma-balancing-recurrence-risk-and-liver-function
#8
Wesley B S Field, Jack W Rostas, Prejesh Philps, Charles R Scoggins, Kelly M McMasters, Robert C G Martin
BACKGROUND: The goal of this study was to compare the outcome after partial hepatectomy for hepatocellular carcinoma (HCC) in which a margin less than or equal to 5 mm or greater than 5 mm was achieved. METHODS: A review of our 3300-patient prospective HPB database was performed from 12/2002 to 4/2015. Patients were stratified into two groups: resection margins ≤5 ("narrow") and >5 mm ("wide") as measured on final pathologic assessment. RESULTS: One-hundred thirty patients were included in the analysis (margin ≤5 mm, n = 41 and margin >5 mm, n = 89)...
August 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28602224/general-surgeon-management-of-complex-hepatopancreatobiliary-trauma-at-a-level-i-trauma-center
#9
Peter Kilen, Alissa Greenbaum, Richard Miskimins, Manuel Rojo, Razvan Preda, Thomas Howdieshell, Stephen Lu, Sonlee West
BACKGROUND: The impact of general surgeons (GS) taking trauma call on patient outcomes has been debated. Complex hepatopancreatobiliary (HPB) injuries present a particular challenge and often require specialized care. We predicted no difference in the initial management or outcomes of complex HPB trauma between GS and trauma/critical care (TCC) specialists. MATERIALS AND METHODS: A retrospective review of patients who underwent operative intervention for complex HPB trauma from 2008 to 2015 at an ACS-verified level I trauma center was performed...
May 11, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28600711/what-s-in-a-name-tensions-between-formal-and-informal-communities-of-practice-among-regional-subspecialty-cancer-surgeons
#10
Simon C Kitto, Rachel E Grant, Jennifer Peller, Carol-Anne Moulton, Steven Gallinger
In 2007 the Cancer Care Ontario Hepatobiliary-Pancreatic (HPB) Community of Practice was formed during the wake of provincial regionalization of HPB services in Ontario, Canada. Despite being conceptualized within the literature as an educational intervention, communities of practice (CoP) are increasingly being adopted in healthcare as quality improvement initiatives. A qualitative case study approach using in-depth interviews and document analysis was employed to gain insight into the perceptions and attitudes of the HPB surgeons in the CoP...
June 9, 2017: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/28578825/the-impact-of-a-clinical-pathway-on-patient-postoperative-recovery-following-pancreaticoduodenectomy
#11
Amélie Tremblay St-Germain, Katharine S Devitt, Daniel J Kagedan, Beverly Barretto, Stephanie Tung, Steven Gallinger, Alice C Wei
BACKGROUND: Pancreaticoduodenectomies (PD) are complex surgical procedures. Clinical pathways (CPW) are surgical process improvement tools that guide postoperative recovery and are associated with high quality care. Our objective was to report the quality of surgical care following implementation of a CPW. METHODS: We developed and implemented a CPW for patients undergoing PD at a single high volume hepato-pancreato-biliary (HPB) centre. Patient outcomes were collected prospectively during the implementation period...
June 1, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28495435/validation-of-clinical-risk-score-for-colorectal-liver-metastases-resected-in-a-contemporary-multicenter-cohort
#12
Paul Beamish, Madeline Lemke, Jennifer Li, Elijah Dixon, Mauro T Abraham, Roberto Hernandez Alejandro, Sean Bennett, Guillaume Martel, Paul J Karanicolas
BACKGROUND: Recent advances in care for colorectal liver metastases (CRLM) have lengthened 5-year survival. In this new era, prognostic tools such as the clinical risk score (CRS) for colorectal liver metastases require reevaluation. METHODS: Patients undergoing resection for CRLM between 2008 and 2012 at 4 specialty hepatobiliary centers in Canada (N = 740) were stratified by CRS and analyzed in Kaplan-Meier survival curves. Primary outcome of overall survival (OS) and secondary outcome of recurrence-free survival (RFS)...
May 8, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://www.readbyqxmd.com/read/28462447/predictive-power-of-the-nsqip-risk-calculator-for-early-post-operative-outcomes-after-whipple-experience-from-a-regional-center-in-northern-ontario
#13
Henry Y Jiang, Erica L Kohtakangas, Kengo Asai, Jeffrey B Shum
BACKGROUND: NSQIP Risk Calculator was developed to allow surgeons to inform their patients about their individual risks for surgery. Its ability to predict complication rates and length of stay (LOS) has made it an appealing tool for both patients and surgeons. However, the NSQIP Risk Calculator has been criticized for its generality and lack of detail towards surgical subspecialties, including the hepatopancreaticobiliary (HPB) surgery. We wish to determine whether the NSQIP Risk Calculator is predictive of post-operative complications and LOS with respect to Whipple's resections for our patient population...
May 2, 2017: Journal of Gastrointestinal Cancer
https://www.readbyqxmd.com/read/28414792/characterization-of-hydroxypropyl-beta-cyclodextrins-used-in-the-treatment-of-niemann-pick-disease-type-c1
#14
Alfred L Yergey, Paul S Blank, Stephanie M Cologna, Peter S Backlund, Forbes D Porter, Allan J Darling
2-Hydroxypropyl-beta-cyclodextrin (HPβCD) has gained recent attention as a potential therapeutic intervention in the treatment of the rare autosomal-recessive, neurodegenerative lysosomal storage disorder Niemann-Pick Disease Type C1 (NPC1). Notably, HPβCD formulations are not comprised of a single molecular species, but instead are complex mixtures of species with differing degrees of hydroxypropylation of the cyclodextrin ring. The degree of substitution is a critical aspect of the complex mixture as it influences binding to other molecules and thus could potentially modulate biological effects...
2017: PloS One
https://www.readbyqxmd.com/read/28371248/randomized-controlled-trial-of-perioperative-antimicrobial-therapy-based-on-the-results-of-preoperative-bile-cultures-in-patients-undergoing-biliary-reconstruction
#15
Kunishige Okamura, Kimitaka Tanaka, Takumi Miura, Yoshitsugu Nakanishi, Takehiro Noji, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano
BACKGROUND: The high frequency of surgical site infections (SSIs) after hepato-pancreato-biliary (HPB) surgery is a problem that needs to be addressed. This prospective, randomized, controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI. METHODS: Participants comprised 126 patients who underwent HPB (bile duct, gallbladder, ampullary, or pancreatic) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 (UMIN Clinical Trial Registry #00001278)...
July 2017: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/28365960/the-nouvelle-vague-of-surgeons-in-pancreatic-surgery-can-they-rise-to-the-legacy-of-current-surgeons
#16
Alexandros Papalampros, Demetrios Moris, Mohammad Fard-Aghaie, Gregor A Stavrou, Evangelos Felekouras, Klaus Niehaus, Karl Oldhafer
PURPOSE: Pancreatic surgery is still thought as a challenging field even for experienced hepatobilliary (HPB) surgeons and high volume tertiary centers. The purpose of this study was to present the results (mortality and morbidity) of pancreatic surgery in a high volume center, in operations performed solely by inexperienced surgeons (two 6th year residents and a HPB fellow) under the supervision of expert surgeons on the field. METHODS: Forty-one consecutive patients who underwent curative-intent pancreatic resection with a modified pancreaticojejunostomy between January 2010 and December 2014 at Asklepios Hospital Barmbek, Germany, were identified from our institutional computer-based database...
January 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/28290711/visualising-a-rare-and-complex-case-of-advanced-hilar-cholangiocarcinoma
#17
Jia Qu, Albert Fung, Paul Kelly, Gordon Tait, Paul D Greig, Anne Agur, Ian D McGilvray, Jodie Jenkinson
The Toronto Video Atlas of Liver, Pancreas, Biliary, and Transplant Surgery (TVASurg) is a free online library of three-dimensional (3D) animation-enhanced surgical videos, designed to instruct surgical fellows in hepato-pancreato-biliary (HPB) and transplant procedures. The video 'Klatskin tumours: Extended left hepatectomy with complex portal vein reconstruction and in situ cold perfusion of the liver', which is available to watch at http://TVASurg.ca , is a unique and valuable visual resource for surgeons in training to assist them in learning this rare procedure...
January 2017: Journal of Visual Communication in Medicine
https://www.readbyqxmd.com/read/28284554/effects-of-biochar-on-reducing-the-abundance-of-oxytetracycline-antibiotic-resistance-genes-and-human-pathogenic-bacteria-in-soil-and-lettuce
#18
Manli Duan, Haichao Li, Jie Gu, Xiaxia Tuo, Wei Sun, Xun Qian, Xiaojuan Wang
Antibiotics and antibiotic resistance genes (ARGs) in soil can affect human health via the food chain. Biochar is a soil amendment but its impacts on ARGs and the microbial communities associated with soil and vegetables are unclear. Therefore, we established three lettuce pot culture experiments, i.e., O300: 300 mg/kg oxytetracycline (OTC), BO300: 300 mg/kg OTC + 2% biochar, and a control without OTC or biochar. We found that under BO300, the relative abundances of ARGs were reduced by 51.8%, 43.4%, and 44...
May 2017: Environmental Pollution
https://www.readbyqxmd.com/read/28261699/effect-of-polylactic-film-surgi-wrap-on-preventing-postoperative-ileus-after-major-hepato-pancreato-biliary-surgery
#19
Chang Hyung Lee, Hongbeom Kim, In Woong Han, Suh Min Kim, Beom Seok Kwak, Yong Hae Baik, Young Jin Park, Min Gu Oh
BACKGROUNDS/AIMS: Major hepato-pancreato-biliary (HPB) surgery is usually performed via an open method rather than a laparoscopic method. Postoperative ileus (POI) is a classic complication after open surgery. The purpose of this study was to determine whether polylactic film is useful in the prevention of POI. METHODS: A total of 179 patients who underwent major HPB surgery between 2005 and 2014, were retrospectively reviewed. A diagnosis of POI was made by a physical examination, laboratory, and radiological findings...
November 2016: Annals of Hepato-Biliary-Pancreatic Surgery
https://www.readbyqxmd.com/read/28258447/time-to-ct-and-surgery-for-hpb-trauma-in-scotland-prior-to-the-introduction-of-major-trauma-centres
#20
P S McKechnie, D A Kerslake, R W Parks
AIMS: To assess the time taken to CT and emergency surgery for trauma patients with an injury to liver, spleen or pancreas prior to the introduction of major trauma centres (MTCs) in Scotland. METHODS: A search was performed of the Scottish Trauma Audit Group database for any patient with relevant injuries over a 2-year period. Primary outcome measures were time to CT and emergency surgery. Patient demographics were also recorded. RESULTS: A total of 211 patients were identified of whom 23 had more than one organ affected...
July 2017: World Journal of Surgery
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