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Zhang S, Tuerganbayi K, Wang J, Liu H, Shen P, Guo Y, Zhong Y, Feng Y, Ma M, Yao W, Xia H, Huang K, Si Y, Dai A, Zou J. Incorporating preoperative and intraoperative data to predict postoperative pneumonia in elderly patients undergoing non-cardiothoracic surgery: The online two-stage prediction tool. Geriatr Nurs 2025; 62:244-253. [PMID: 40068226 DOI: 10.1016/j.gerinurse.2025.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 02/02/2025] [Accepted: 02/25/2025] [Indexed: 04/08/2025]
Abstract
BACKGROUND Prior research on postoperative pneumonia (POP) risk models focused on preoperative factors but overlooked intraoperative variables vital for precision. These models also neglected the higher-risk elderly population. This study seeks to develop and evaluate preoperative and combined models to predict POP risk in elderly patients undergoing non-cardiothoracic surgery. METHODS A retrospective cohort of 444 patients who underwent non-cardiothoracic surgery at Nanjing First Hospital from March 2021 to April 2022 was included. Univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression were employed to develop preoperative and combined logistic regression models. RESULTS The area under the receiver operating characteristic curve for both models exceeded 0.80, indicating excellent discriminatory ability. Furthermore, the combined model demonstrated superior predictive accuracy compared to the preoperative model. CONCLUSION This study developed preoperative and combined nomograms that offer practical and innovative tools for clinicians to predict POP risk and improve patient care.
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Affiliation(s)
- Siyu Zhang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Kunduzi Tuerganbayi
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Jiawen Wang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Hao Liu
- State Key Laboratory of Natural Medicines, Key Laboratory of Drug Metabolism, China Pharmaceutical University, Nanjing 211198, China
| | - Po Shen
- Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 211899, China; Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yaoyi Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yi Zhong
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yue Feng
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Mingtao Ma
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Anesthesiology, Leping People's Hospital, Leping 333300, China
| | - Weifeng Yao
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Huaming Xia
- Nanjing Xiaheng Network System Co., Ltd, Nanjing 210019, China
| | - Kaizong Huang
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yanna Si
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
| | - Anran Dai
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China.
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
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Li S, Lin X, Huang J, Rao J, Lin M, Li F. Effectiveness of nasogastric tube decompression in mitigating delayed bleeding following endoscopic submucosal dissection for early gastric cancers. Surg Endosc 2025; 39:1043-1049. [PMID: 39681681 DOI: 10.1007/s00464-024-11431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 11/14/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND AND AIMS Nasogastric tube decompression (NGTD) has been a standard practice following endoscopic submucosal dissection (ESD) for early gastric cancers (EGCs) in clinical settings for several years. Nevertheless, there remains a dearth of research assessing the efficacy of NGTD in preventing delayed bleeding after ESD. METHODS From January 2021 to December 2022, eligible patients who underwent gastric ESD for EGCs were categorized into two groups: NGTD group and no NGTD group. A retrospective Propensity Score Matching (PSM) study was performed to analyzed the data. RESULTS The delayed bleeding rate did not exhibit a significant decrease in the NGTD group, when compared with the no NGTD group. In the multivariate analysis, the size of the resected lesion emerged as the sole predictive factor for delayed bleeding after ESD, as opposed to the use of NGTD. Moreover, our findings revealed that hospital stay and costs were higher in the NGTD group. (8 days vs 7 days, p = 0.033, 3348.19$ vs 2840.28$, p = 0.00, respectively). CONCLUSION The utilization of NGTD showed no significant impact on delayed bleeding after ESD for EGCs and was correlated with hospital stay and costs. Therefore, the routine application of NGTD following ESD for EGCs may not be deemed necessary.
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Affiliation(s)
- Siyu Li
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Ge Lake Road No.68,Wujin District, Changzhou, 213000, Jiangsu, China
| | - Xueyi Lin
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Ge Lake Road No.68,Wujin District, Changzhou, 213000, Jiangsu, China
| | - Jin Huang
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Ge Lake Road No.68,Wujin District, Changzhou, 213000, Jiangsu, China
| | - Jun Rao
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Ge Lake Road No.68,Wujin District, Changzhou, 213000, Jiangsu, China
| | - Min Lin
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Ge Lake Road No.68,Wujin District, Changzhou, 213000, Jiangsu, China.
| | - Fen Li
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Ge Lake Road No.68,Wujin District, Changzhou, 213000, Jiangsu, China.
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Longo F, Panza E, Rocca L, Biffoni B, Lucinato C, Cintoni M, Mele MC, Papa V, Fiorillo C, Quero G, De Sio D, Menghi R, Alfieri S, Langellotti L. Enhanced Recovery After Surgery (ERAS) in Pancreatic Surgery: The Surgeon's Point of View. J Clin Med 2024; 13:6205. [PMID: 39458155 PMCID: PMC11508928 DOI: 10.3390/jcm13206205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 10/08/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
Pancreatic surgery is complex and associated with higher rates of morbidity and mortality compared to other abdominal surgeries. Over the past decade, the introduction of new technologies, such as minimally invasive approaches, improvements in multimodal treatments, advancements in anesthesia and perioperative care, and better management of complications, have collectively improved patient outcomes after pancreatic surgery. In particular, the adoption of Enhanced Recovery After Surgery (ERAS) recommendations has reduced hospital stays and improved recovery times, as well as post-operative outcomes. The aim of this narrative review is to highlight the surgeon's perspective on the ERAS program for pancreatic surgery, with a focus on its potential advantages for perioperative functional recovery outcomes.
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Affiliation(s)
- Fabio Longo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Edoardo Panza
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Lorenzo Rocca
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Beatrice Biffoni
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Chiara Lucinato
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Marco Cintoni
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (M.C.); (M.C.M.)
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valerio Papa
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Davide De Sio
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
| | - Roberta Menghi
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo Francesco Vito 4, 00168 Roma, Italy
| | - Lodovica Langellotti
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (E.P.); (L.R.); (B.B.); (C.L.); (V.P.); (C.F.); (G.Q.); (D.D.S.); (R.M.); (S.A.); (L.L.)
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Li M, Yin M, Jiang X, Yang X, Liu L. A commentary on 'Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients'. Int J Surg 2024; 110:3099-3100. [PMID: 38348860 DOI: 10.1097/js9.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Meijing Li
- Hepatobiliary&Pancreatic&Spleen Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong, People's Republic of China
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Ayabe RI, Prakash LR, Bruno ML, Newhook TE, Maxwell JE, Arvide EM, Dewhurst WL, Kim MP, Ikoma N, Snyder RA, Lee JE, Katz MHG, Tzeng CWD. Differential Gains in Surgical Outcomes for High-Risk vs Low-Risk Pancreaticoduodenectomy with Successive Refinements of Risk-Stratified Care Pathways. J Am Coll Surg 2023; 237:4-12. [PMID: 36786469 DOI: 10.1097/xcs.0000000000000652] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The use of risk-stratified pancreatectomy care pathways (RSPCPs) is associated with reduced length of stay (LOS). This study sought to evaluate the impact of successive pathway revisions with the hypothesis that high-risk patients require iterative pathway revisions to optimize outcomes. STUDY DESIGN A prospectively maintained database (October 2016 to December 2021) was evaluated for pancreaticoduodenectomy patients managed with RSPCPs preoperatively assigned based on postoperative pancreatic fistula (POPF) risk. Launched in October 2016 (version [V] 1), RSPCPs were optimized in February 2019 (V2) and November 2020 (V3). Targeted pathway components included earlier nasogastric tube removal, diet advancement, reduced intravenous fluids and opioids, institution-specific drain fluid amylase cutoffs for early day 3 removal, and patient education. Primary outcome was LOS. Secondary outcomes included major complication (Accordion grade 3+), POPF (International Study Group for Pancreatic Surgery Grade B/C), and delayed gastric emptying (DGE). RESULTS Of 481 patients, 234 were managed by V1 (83 high-risk), 141 by V2 (43 high-risk), and 106 by V3 (43 high-risk). Median LOS reduction was greatest in high-risk patients with a 7-day reduction (pre-RSPCP, 12 days; V1, 9 days; V2, 7 days; V3, 5 days), compared with low-risk patients (pre-pathway, 10 days; V1, 6 days; V2, 5 days; V3, 4 days). Complications decreased significantly among high-risk patients (V1, 45%; V2, 33%; V3, 19%; p < 0.001), approaching rates in low-risk patients (V1, 21%; V2, 20%; V3, 14%). POPF (V1, 33%; V2, 23%; V3, 16%; p < 0.001) and DGE (V1, 23%; V2, 22%; V3, 14%; p < 0.001) improved among high-risk patients. CONCLUSIONS Risk-stratified pancreatectomy care pathways are associated with reduced LOS, major complication, Grade B/C fistula, and DGE. The easiest gains in surgical outcomes are generated from the immediate improvement in the patients most likely to be fast-tracked, but high-risk patients benefit from successive application of the learning health system model.
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Affiliation(s)
- Reed I Ayabe
- From the Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
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Halle-Smith JM, Powell-Brett SF, Hall LA, Duggan SN, Griffin O, Phillips ME, Roberts KJ. Recent Advances in Pancreatic Ductal Adenocarcinoma: Strategies to Optimise the Perioperative Nutritional Status in Pancreatoduodenectomy Patients. Cancers (Basel) 2023; 15:cancers15092466. [PMID: 37173931 PMCID: PMC10177139 DOI: 10.3390/cancers15092466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy for which the mainstay of treatment is surgical resection, followed by adjuvant chemotherapy. Patients with PDAC are disproportionately affected by malnutrition, which increases the rate of perioperative morbidity and mortality, as well as reducing the chance of completing adjuvant chemotherapy. This review presents the current evidence for pre-, intra-, and post-operative strategies to improve the nutritional status of PDAC patients. Such preoperative strategies include accurate assessment of nutritional status, diagnosis and appropriate treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions include accurate monitoring of nutritional intake and proactive use of supplementary feeding methods, as required. There is early evidence to suggest that perioperative supplementation with immunonutrition and probiotics may be beneficial, but further study and understanding of the underlying mechanism of action are required.
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Affiliation(s)
- James M Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Sarah F Powell-Brett
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Lewis A Hall
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Sinead N Duggan
- Department of Surgery, Trinity College Dublin, University of Dublin, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Oonagh Griffin
- Department of Nutrition and Dietetics, St. Vincent's University Hospital, D04 T6F4 Dublin, Ireland
| | - Mary E Phillips
- Department of Nutrition and Dietetics, Royal Surrey County Hospital, Guildford GU2 7XX, UK
| | - Keith J Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
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Lengthened Efferent Limb in Braun Enteroenterostomy Reduces Delayed Gastric Emptying After Pancreaticoduodenectomy. World J Surg 2023; 47:1263-1270. [PMID: 36719447 DOI: 10.1007/s00268-023-06925-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), but a method to prevent DGE has not been established. This study aims to demonstrate a novel technique utilizing a lengthened efferent limb in Billroth-II (B-II) reconstruction during PD and to evaluate the impact of the longer efferent limb on DGE occurrence. METHODS Patients who underwent PD with B-II reconstruction were divided into two groups: PDs with lengthened (50-60 cm) efferent limb (L group) and standard length (0-30 cm) efferent limb (S group). Postoperative outcomes were compared. DGE was defined and graded according to the International Study Group of Pancreatic Surgery criteria. RESULTS Among 283 consecutive patients who underwent PD from 2002 to 2021, 206 patients were included in this study. Patients who underwent Roux-en-Y reconstruction (n = 77) were excluded. Compared with the S group, the L group included older patients and those who underwent PD after 2016 (p = 0.025, < 0.001, respectively). D2 lymphadenectomy, antecolic route reconstruction, and Braun enteroenterostomy were performed more frequently in the L group (p = 0.040, < 0.001, < 0.001, respectively). The rate of DGE was significantly decreased to 6% in the L group, compared with 16% in the S group (p = 0.027), which might lead to a shorter hospital stay in the L group (p < 0.001). Multivariable analysis identified two factors as independent predictors for DGE: intraabdominal abscess [odds ratio (OR) 5.530, p = 0.008] and standard efferent limb length (OR 2.969, p = 0.047). CONCLUSION A lengthened efferent limb in Braun enteroenterostomy could reduce DGE after PD.
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Lassen K. The tube, the pancreatoduodenectomy-and the dogma. BJS Open 2021; 5:zrab113. [PMID: 34922332 PMCID: PMC8684476 DOI: 10.1093/bjsopen/zrab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
Routine use of NG-tubes following pancreatoduodenectomies is not indicated
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Affiliation(s)
- Kristoffer Lassen
- HPB-Surgery, Oslo University Hospital at Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, Arctic University of Norway, Tromsø, Norway
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