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Kauffmann EF, Napoli N, Ginesini M, Boggi U. Division of the neck of the pancreas in minimally invasive surgery without a preemptive retropancreatic tunnel. Updates Surg 2023; 75:769-773. [PMID: 36820963 DOI: 10.1007/s13304-023-01459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Affiliation(s)
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
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Ball CG. Getting going: Incorporating ultrasound into an HPB practice. Surg Open Sci 2022; 8:47-49. [PMID: 35308135 PMCID: PMC8927842 DOI: 10.1016/j.sopen.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
The incorporation of ultrasound into a hepatopancreatobiliary surgical practice is both exciting and potentially intimidating. Although it is relatively straightforward to obtain detailed intraoperative ultrasound training from a small variety of formal programs, didactic curriculum, and mentorship experiences, seamless integration of this new knowledge into a hepatopancreatobiliary practice can be more challenging than expected. Although this is particularly true when a graduate begins a new practice, it is also relevant when incorporating hepatopancreatobiliary ultrasound into a mature group practice environment. This review outlines knowing your environment, certification and competency, credentialing and privileging, transition to independent practice, and maintaining competence.
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Affiliation(s)
- Chad G. Ball
- Corresponding author: Tel.: + 1 403 944 3417; fax: + 1 403 944 8799.
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Udhayachandhar R, Otokwala J, Korula PJ, Rymbai M, Chandy TT, Joseph P. Perioperative factors impacting intensive care outcomes following Whipple procedure: A retrospective study. Indian J Anaesth 2020; 64:216-221. [PMID: 32346169 PMCID: PMC7179786 DOI: 10.4103/ija.ija_727_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/12/2019] [Accepted: 02/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background and Aims Whipple procedure is associated with perhaps the most perioperative morbidity and mortality amongst surgical procedures. Current data regarding their ICU profile and outcomes are lacking. Thus, in the present study, we aimed to determine perioperative factors affecting patient-centred outcomes following the Whipple procedure. Methods In a cohort of patients undergoing pylorus-sparing pancreaticoduodenectomies, we strove to determine perioperative variables that may impact outcomes. Unfavourable outcomes (composite of mortality, prolonged ICU stay of more than 14 days or ICU readmission) of patients who underwent the procedure were recorded and logistic regressions analysis of significant variables conducted. Results Around 68 patients recruited over a 20-month period which included 57 males (83.8%); mean age was 53.4(±11.2) with mean acute physiology and chronic health evaluation (APACHE) II score12.5 (±6.1). Nineteen patients remained intubated at the end of procedures (27.9%). Median ICU stay was 2 days (IQR 2-3). Unfavourable ICU outcomes were 14 in number (20.6%) and 2 (2.9%) hospital deaths occurred. Pulmonary complications occurred in 12 patients (17.7%) and non-pulmonary complications occurred in 41 patients (60.3%). In a multiple logistic regression analysis, the APACHE score 1.34 (1.09-1.64) and pulmonary complications 17.3 (2.1-145) were variables that were identified as predictors of unfavourable outcomes. Conclusion The APACHE II score may reliably predict adverse outcomes following Whipple procedure. Although non-pulmonary complications are common, pulmonary complications in these patients adversely impact patient outcomes.
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Affiliation(s)
- R Udhayachandhar
- Division of Critical Care, CMC Hospital, Vellore, Tamil Nadu, India
| | - J Otokwala
- Intensive Care Unit, Department of Anaesthesiology, University of Portharcourt, Porthar Court, Nigeria
| | - Pritish J Korula
- Division of Critical Care, CMC Hospital, Vellore, Tamil Nadu, India
| | - Manbha Rymbai
- Department of Hepatobiliary Surgery, CMC Hospital, Vellore, Tamil Nadu, India
| | - Tony T Chandy
- Department of Anaesthesia, CMC Hospital, Vellore, Tamil Nadu, India
| | - Philip Joseph
- Department of Hepatobiliary Surgery, CMC Hospital, Vellore, Tamil Nadu, India
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Zarzavadjian Le Bian A, Fuks D, Montali F, Cesaretti M, Costi R, Wind P, Smadja C, Gayet B. Predicting the Severity of Pancreatic Fistula after Pancreaticoduodenectomy: Overweight and Blood Loss as Independent Risk Factors: Retrospective Analysis of 277 Patients. Surg Infect (Larchmt) 2019; 20:486-491. [DOI: 10.1089/sur.2019.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Alban Zarzavadjian Le Bian
- Department of Digestive Surgery and Surgical Oncology, Hôpital Avicenne, Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - David Fuks
- Department of Digestive Disease, Oncologic and Metabolic Surgery Institut Mutualiste Montsouris, Paris, France
- Université Paris Descartes, Paris, France
| | - Filippo Montali
- Department of Hepatic, Pancreatic and Biliary Surgery – Hôpital Paul Brousse, Assistance Publique – Hôpitaux de Paris, Villejuif, France
| | | | - Renato Costi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italy
- Department of Digestive Surgery – Assistance Publique – Hôpitaux de Paris Hôpital Antoine Béclère, Université Paris Sud, Clamart, France
| | - Philippe Wind
- Department of Digestive Surgery and Surgical Oncology, Hôpital Avicenne, Assistance Publique – Hôpitaux de Paris, Bobigny, France
| | - Claude Smadja
- Department of Digestive Surgery – Assistance Publique – Hôpitaux de Paris Hôpital Antoine Béclère, Université Paris Sud, Clamart, France
| | - Brice Gayet
- Department of Digestive Disease, Oncologic and Metabolic Surgery Institut Mutualiste Montsouris, Paris, France
- Université Paris Descartes, Paris, France
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Zarzavadjian Le Bian A, Cesaretti M, Tabchouri N, Wind P, Fuks D. Late Pancreatic Anastomosis Stricture Following Pancreaticoduodenectomy: a Systematic Review. J Gastrointest Surg 2018; 22:2021-2028. [PMID: 29980974 DOI: 10.1007/s11605-018-3859-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/21/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND With an increasing postoperative survival and prolonged follow-up, late complications following pancreaticoduodenectomy (PD) have yet to be thoroughly described and analyzed. Among those, pancreatic anastomosis stricture may lead to severe consequences. METHODS A systematic review focusing on pancreaticojejunostomy anastomosis (PJA) stricture. RESULTS PJA stricture incidence reached 1.4-11.4% with a median time interval of 34 months after PD. No risk factor was identified. PJA stricture repercussions were inconsistent but postprandial abdominal pain and recurrent acute pancreatitis were the most common symptoms, followed by impaired pancreatic function. To confirm diagnosis, secretin-enhanced magnetic resonance cholangiopancreatography (SMRCP) sensitivity reached 56-100%. As impaired pancreatic function is not improved by any procedure, only PJA stricture leading to abdominal pain or acute pancreatitis should be considered for treatment. Endoscopic techniques (mainly ultrasound-assisted "rendezvous") should be proposed prior to surgical repair, with a morbidity, an overall technical and clinical success reaching 16.5-33% and 28.6-100% and 33-100%, respectively. Regarding surgical repair, overall morbidity varied between 14.3 and 33%, with a clinical success reaching 26.1-100%. Finally, total pancreatectomy with islet auto-transplantation should be considered only for pain intractable to medical management and recurrent acute pancreatitis which has failed medical, endoscopic, and traditional surgical management strategies. CONCLUSION PJA stricture following PD is a late, unusual, and potentially serious complication. When there is currently no clear consensus, PJA stricture leading to abdominal pain or acute pancreatitis should be considered treatment. With increasing survival after PD, further studies should focus on late complications. CORE TIP Stricture of pancraticojejunostomy is a late and potentially serious complication after pancreaticoduodenectomy. Incidence reaches 1.4-11.4% and no risk factor is identified. Symptoms are inconsistent but postprandial abdominal pain, recurrent acute pancreatitis, and impaired pancreatic function are the most frequent. To confirm diagnosis, secretin-enhanced magnetic resonance cholangiopancreatography is the best modality. Only PJA stricture leading to abdominal pain or acute pancreatitis should be considered for treatment. Endoscopic techniques (mainly ultrasound-assisted "rendezvous") should be proposed prior to surgical repair. Finally, total pancreatectomy with islet auto-transplantation should be considered only for pain intractable to medical management and recurrent acute pancreatitis which has failed medical, endoscopic, and traditional surgical management strategies.
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Affiliation(s)
- Alban Zarzavadjian Le Bian
- Department of Digestive Surgery and Surgical Oncology - Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, 125 rue de Stalingrad, 93000, Bobigny, France.
| | - Manuela Cesaretti
- Department of Digestive Surgery, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncologic and Metabolic Surgery - Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Philippe Wind
- Department of Digestive Surgery and Surgical Oncology - Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris XIII, 125 rue de Stalingrad, 93000, Bobigny, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery - Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'Ecole de Médecine, 75006, Paris, France
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Routine portal vein resection for pancreatic adenocarcinoma shows no benefit in overall survival. Eur J Surg Oncol 2018; 44:1094-1099. [PMID: 29778616 DOI: 10.1016/j.ejso.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extended pancreatic resections including resections of the portal (PV) may nowadays be performed safely. Limitations in distinguishing tumor involvement from inflammatory adhesions however lead to portal vein resections (PVR) without evidence of tumor infiltration in the final histopathological examination. The aim of this study was to analyze the impact of these "false negative" resections on operative outcome and long-term survival. METHODS 40 patients who underwent pancreatic resection with PVR for pancreatic adenocarcinoma (PA) without tumor infiltration of the PV (PVR-group) were identified. In a 1:3 match these patients were compared to 120 patients after standard pancreatic resection without PVR (SPR-group) with regard to operative outcome and overall survival. RESULTS Survival analysis revealed that median survival was significantly shorter in the PVR group (311 days) as compared to the SPR group (558 days), (p = 0.0011, hazard ratio 1.98, 95% CI: 1.31-2.98). Also postoperative complications ≥ Clavien III occurred significantly more often in the PVR group (37.5% vs. 20.8%). CONCLUSIONS Radical resection affords the best chance for long-term survival in patients with PA. Based on the results of this study a routine resection of the PV as recently proposed may however not be recommended.
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Lessons learned from 300 consecutive pancreaticoduodenectomies over a 25-year experience: the “safety net” improves the outcomes beyond surgeon skills. Updates Surg 2017; 69:451-460. [DOI: 10.1007/s13304-017-0490-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 08/20/2017] [Indexed: 12/17/2022]
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Joliat GR, Demartines N, Halkic N, Petermann D, Schäfer M. Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy - A single-center series. Ann Med Surg (Lond) 2016; 13:1-5. [PMID: 27994871 PMCID: PMC5153441 DOI: 10.1016/j.amsu.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/01/2016] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic distal pancreatectomy was introduced 15 years ago, but it is still not widely used. The aim of the study was to compare the postoperative complications and length of stay between open and laparoscopic distal pancreatectomy. Materials and methods A search of our institutional pancreas database was performed. All consecutive distal pancreatectomy patients from 2000 to 2015 were identified. Demographics, peri- and postoperative outcomes were reviewed. Postoperative complications were graded using Clavien classification. Standard statistical analyses were performed. Results One hundred and five patients underwent distal pancreatectomy (45 women, 60 men, median age of 63 years). Seventy-nine cases were performed open and 26 by laparoscopy (conversion rate from laparoscopy to laparotomy: 7/26). Characteristics of both groups were similar. The tumor proportion was similar in both groups (56/79 and 23/26, p = 0.114). Overall complication rate was 41/79 (52%) in the open group and 9/26 (36%) in the laparoscopy group (p = 0.175). Two patients died during hospital stay in the open group compared to 0 in the laparoscopy group (p = 1). The fistula rates were comparable (17/79 and 5/26, p = 1). Median length of stay was shorter for the laparoscopy group (8 vs. 12 days, p < 0.001), as well as the median intermediate care stay (1 vs. 3 days, p = 0.004). Conclusion Short-term outcomes after open and laparoscopic distal pancreatectomy regarding postoperative complications and mortality were similar, but length of stay was significantly shorter for the laparoscopic approach. Hence, laparoscopic distal pancreatectomy should be offered to all suitable patients. Laparoscopy has been recently used more frequently for distal pancreatectomy. Postoperative complications and oncologic outcomes were similar in this study. Length of stay was shorter for the patients operated by laparoscopy. Laparoscopy should be offered when technically feasible.
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Affiliation(s)
| | - Nicolas Demartines
- Corresponding author. Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.Department of Visceral SurgeryUniversity Hospital CHUVRue du Bugnon 46Lausanne1011Switzerland
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D'Angelica MI, Chapman WC. HPB Surgery: The Specialty is Here to Stay, but the Training is in Evolution. Ann Surg Oncol 2016; 23:2123-5. [PMID: 27138384 DOI: 10.1245/s10434-016-5230-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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The role of robotics in widening the range of application of minimally invasive surgery for pancreaticoduodenectomy. Pancreatology 2015; 16:293-4. [PMID: 26774496 DOI: 10.1016/j.pan.2015.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 12/11/2022]
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