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Marco Marino, Gaspare Gulotta, Andrzej L Komorowski
Robotic surgery can help to overcome some technical limitations of laparoscopic pancreaticoduodenectomy thanks to EndoWrist instrumentations and the 3D view. Despite the potential benefits, its employment is still low and controversial. We focused on some important technical details crucial for a safe robotic pancreatectomy. After performing 52 robotic pancreatic resections that included 10 pancreatoduodenectomies, the authors describe their technique. The review of literature on robotic and laparoscopic duodenopancreatectomy is also performed in order to evaluate possible benefits of the robotic platform...
April 2018: Indian Journal of Surgery
Shohei Eto, Masashi Ishikawa, Michihito Asanoma, Yoshihiko Tashiro, Kazuo Matsuyama, Takehito Oshio
A 62-year-old man underwent endoscopic mucosal resection for early gastric cancer. The follow-up computed tomography revealed biliary dilatation. The tumor was located in the lower bile duct with biliary dilatation, and no evidence of metastasis in other organs was noted. The patient underwent subtotal stomach-preserving pancreatoduodenectomy with pancreaticogastrostomy and Billroth I anastomosis. At 13 months after the operation, gastrointestinal endoscopy revealed a tumor lesion in the pancreaticogastrostomy site...
May 2018: Annals of Hepato-Biliary-Pancreatic Surgery
Z Liu, I S Peneva, F Evison, S Sahdra, D F Mirza, R M Charnley, R Savage, P A Moss, K J Roberts
BACKGROUND: Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined. METHODS: Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied. RESULTS: 90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period...
June 9, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Ashutosh Gupta, Sourabh Nandi, Santanu Tiwari, Amit Choraria, Vivek Chaudhary
The aim of this paper is to study the outcome of single-layer end to side dunking pancreatojejunostomy technique in 32 patients of malignant pancreatic disease undergoing Whipple's surgery in a tertiary care oncology centre in India. From January 2013 to January 2016, 32 consecutive patients who underwent pancreatoduodenectomy for malignant diseases were analysed retrospectively. All the patients underwent standard Whipple's operation. Pancreatojejunostomy was established in a single-layer end to side dunking manner with PDS 4-0...
June 2018: Indian Journal of Surgical Oncology
Keisuke Takemura, Satoru Sekoguchi, Satoki Yamane, Katsutoshi Yamaguchi, Tatsuro Oaku, Yuma Hotta, Nobuhisa Yamada, Yutaka Isozaki, Yasuyuki Nagao, Hirokazu Oyamada, Kazuki Maeda, Tetsuya Itou
An 80-year-old man had a medical history of chronic hepatitis C and pancreatoduodenectomy. We detected recurrence of hepatocellular carcinoma, and performed transcatheter arterial chemoembolization, instead of radiofrequency ablation or surgery, because of the patient's medical history of bile duct reconstruction and liver dysfunction. On the second day, he was diagnosed with a gas-forming liver abscess and underwent liver abscess drainage. Clostridium perfringens and sordellii were detected by aspiration and the blood culture...
2018: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
Eunjung Kim, Jae Seung Kang, Youngmin Han, Hongbeom Kim, Wooil Kwon, Jae Ri Kim, Sun-Whe Kim, Jin-Young Jang
BACKGROUND: This study investigated the clinical outcomes according to the preoperative nutritional status and to identify factors influencing long-term unrecovered nutritional status. METHODS: Data were prospectively collected from 355 patients who underwent PD between 2008 and 2014. Nutritional status was evaluated by Mini Nutrition Assessment (MNA) and patients were classified into group A (malnourished), group B (risk-of-malnutrition), or group C (well-nourished)...
June 7, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Ryo Ashida, Yukiyasu Okamura, Kanako Wakabayashi-Nakao, Takashi Mizuno, Shuichi Aoki, Katsuhiko Uesaka
AIMS: To investigate whether preoperative enteral diets -enriched in eicosapentaenoic acid (EPA) supplements could reduce the incidence of hypercytokinemia after pancreatoduodenectomy (PD) in a double-blinded randomized -controlled trial. METHODS: Patients with resectable periampullary cancer were randomized into either the control group or the treatment group. Patients in the treatment group received oral supplementation (600 kcal/day) containing EPA for 7 days before surgery...
June 8, 2018: Digestive Surgery
Katharina Joechle, Claudius Conrad
While clinical outcomes of minimally invasive pancreatic resection (MIPR) compared to open surgery are well examined, only few studies focus on its associated cost. The aim of this study is to evaluate cost analyses comparing MIPR to open pancreatic resection (OPR). A systematic review of the literature using PubMed of all published studies between 2000 and 2017 was performed. Studies reporting on cost of laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreatoduodenectomy (LPD) compared to open surgery were identified...
June 2018: Journal of Hepato-biliary-pancreatic Sciences
Naru Kondo, Yoshiaki Murakami, Kenichiro Uemura, Naoya Nakagawa, Kenjiro Okada, Shinya Takahashi, Taijiro Sueda
BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the prognostic impact of postoperative complications after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) stratified by resectability status. METHODS: Medical records of 226 patients with pancreatic head carcinoma who underwent PD, including 115 with resectable (R) and 111 with borderline resectable/unresectable (BR/UR) PDAC, were reviewed retrospectively. Major complications were defined as grade III or IV based on the Clavien-Dindo classification system...
June 7, 2018: Journal of Surgical Oncology
Judith E K R Hentzen, Marloes A Smit, Marjan J Bruins, Coen G B M Rupert, Jennifer Schreinemakers, Gijs J H M Ruijs, Gijs A Patijn
BACKGROUND: The most common complications after pancreaticoduodenectomy (PD) are infectious, despite the standard use of cefazolin and metronidazole prophylaxis. Pre-operative biliary drainage (PBD) is a well-known risk factor for infectious complications. The objective was to identify the pathogens in intra-operative bile cultures in patients undergoing PD-with and without PBD-to determine the optimal antimicrobial prophylaxis regimen. PATIENTS AND METHODS: Patients who underwent PD between 2009 and 2016 were identified retrospectively in three major teaching hospitals in The Netherlands...
June 6, 2018: Surgical Infections
Leonardo S Lino-Silva, Rosa A Salcedo-Hernández, Patricia Segales-Rojas, César Zepeda-Najar
BACKGROUND: Lymph node metastasis (LNM) is a strong prognostic factor in the cancer of the pancreatobiliary tree, but it is influenced by the number of lymph nodes (LNs). The lymph node ratio (LNR) is considered a more reliable factor than the number of LNM. The aim was to examine the LN retrieval and the LNR of 3 pathologic work-up strategies. METHODS: Pancreaticoduodenectomies (n = 165) were analyzed comparing 3 pathological dissection techniques, classified as "control," "Verbeke method," and "Adsay method" groups...
June 1, 2018: International Journal of Surgical Pathology
Sjors Klompmaker, Jony van Hilst, Ulrich F Wellner, Olivier R Busch, Andrea Coratti, Mathieu D'Hondt, Safi Dokmak, Sebastiaan Festen, Mustafa Kerem, Igor Khatkov, Daan J Lips, Carlo Lombardo, Misha Luyer, Alberto Manzoni, Izaäk Q Molenaar, Edoardo Rosso, Olivier Saint-Marc, Franky Vansteenkiste, Uwe A Wittel, Bert Bonsing, Bas Groot Koerkamp, Mohammed Abu Hilal, David Fuks, Ignasi Poves, Tobias Keck, Ugo Boggi, Marc G Besselink
OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017)...
June 1, 2018: Annals of Surgery
Yoshiro Fujii, Atsushi Nanashima, Masahide Hiyoshi, Naoya Imamura, Koichi Yano, Takeomi Hamada
Considerable attention has been focused on nonalcoholic fatty liver disease (NAFLD) which occasionally develops after pancreatoduodenectomy (PD). The present study aimed to clarify the prevalence, sequential change in properties and risk factors for NAFLD development after PD. We enrolled 196 patients who underwent PD and a computed tomography (CT) scan 1 month, 6 months and 1 year after surgery. NAFLD was defined as a liver-to-spleen attenuation ratio on plain CT of <0.9. We compared various clinical factors between the NAFLD group and the control group...
September 2017: Annals of gastroenterological surgery
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
Jason W Denbo, Morgan Bruno, Whitney Dewhurst, Michael P Kim, Ching-Wei Tzeng, Thomas A Aloia, Jose Soliz, Barbara Bryce Speer, Jeffrey E Lee, Matthew H G Katz
BACKGROUND: Postoperative pancreatic fistula is associated with adverse events, increased duration of stay and hospital costs. We developed perioperative care pathways stratified by postoperative pancreatic fistula risk with the aims of minimizing variations in care, improving quality, and decreasing costs. STUDY DESIGN: Three unique risk-stratified pancreatectomy clinical pathways-low-risk pancreatoduodenectomy, high-risk pancreatoduodenectomy, and distal pancreatectomy were developed and implemented...
May 25, 2018: Surgery
Simon Kuesters, Sophia Chikhladzen, Frank Makowiec, Olivia Sick, Stefan Fichtner-Feigl, Ulrich T Hopt, Uwe A Wittel
INTRODUCTION: Laparoscopic resections of the pancreatic head are increasingly performed. Several studies show that they are comparable to open operations in terms of postoperative morbidity. However, since a substantial proportion of pancreatic head resections are necessary for pancreatic adenocarcinoma the oncologic safety and outcome of minimally invasive operations is of interest. In this study we evaluated oncologic outcome and survival after laparoscopically assisted pancreatic head resection for ductal adenocarcinoma...
May 25, 2018: International Journal of Surgery
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
Guus W de Klein, Joop van Baarlen, Leonie J Mekenkamp, Mike S L Liem, Joost M Klaase
Signet ring cell carcinoma (SRCC) of the ampulla of Vater is an extremely rare tumor. Our case describes a 45-year-old female presenting with jaundice and pruritus. Computed tomography, endoscopy, and endoscopic retrograde cholangiopancreatography showed a tumor of the ampulla of Vater without distant metastasis. Histological biopsy confirmed a malignant tumor with SRCC characteristics and immunohistochemical staining revealed a mixed type profile (both intestinal and pancreatobiliary characteristics). A pylorus-preserving pancreatoduodenectomy was performed and the patient recovered without complications...
January 2018: Case Reports in Gastroenterology
Yusuke Kimura, Daiki Yasukawa, Yuki Aisu, Tomohide Hori
BACKGROUND Pancreatic surgeries have undergone substantial development. Pancreaticoduodenectomy and pylorus-preserving pancreatoduodenectomy inherently require reconstruction. In 1960, Professor Imanaga introduced a reconstructive technique performed in the order of the gastric remnant, pancreatic duct, and biliary tree from the viewpoint of physiologic function after pancreaticoduodenectomy. We herein report our experience with Imanaga's first method during pylorus-preserving pancreatoduodenectomy and retrospectively evaluate the short- and long-term outcomes...
May 28, 2018: American Journal of Case Reports
E Vicente, Y Quijano, B Ielpo, H Duran
BACKGROUND: Pancreatectomy for locally advanced adenocarcinoma affecting the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) is still under discussion [1]. However, in selected cases, in light of the advancement of recent neoadjuvant treatments, it must be taken into account [2,3]. This video demonstrates some of the technical aspects of SMA and SMV resection as well as some tips of vascular reconstruction. METHODS: A 48-year-old man with a large adenocarcinoma of the uncinated process affecting the SMA and SMV underwent 3 cycles of gemcitabine and nab-paclitaxel neoadjuvancy...
September 2017: Surgical Oncology
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