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Villaseñor-Echavarri R, Melchor-Ruan J, Aranda-Audelo M, Arredondo-Saldaña G, Volkow-Fernandez P, Manzano-Robleda MDC, Padilla-Rosciano AE, Vilar-Compte D. Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico. Hepatobiliary Pancreat Dis Int 2023:S1499-3872(23)00049-8. [PMID: 37076378 DOI: 10.1016/j.hbpd.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections (SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. METHODS We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. RESULTS A total of 219 patients were enrolled in the study; 101 (46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. CONCLUSIONS SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes; however, survival was unaffected.
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Affiliation(s)
- Rodrigo Villaseñor-Echavarri
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico; School of Medicine, Universidad Panamericana, Augusto Rodin No. 498, Insurgentes Mixcoac, Benito Juárez, Mexico City, Mexico
| | - Javier Melchor-Ruan
- Department of Digestive Tube and Hepatopancreatobiliary Tumors, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico
| | - Mercedes Aranda-Audelo
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico; Department of Infectious Diseases, Hospital Manuel Gea González, Calz. de Tlalpan 4800, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico
| | - Gabriela Arredondo-Saldaña
- Department of Digestive Tube and Hepatopancreatobiliary Tumors, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico
| | - Patricia Volkow-Fernandez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico
| | - Maria Del Carmen Manzano-Robleda
- Gastrointestinal and Endoscopy Department, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico
| | - Alejandro E Padilla-Rosciano
- Department of Digestive Tube and Hepatopancreatobiliary Tumors, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico
| | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Mexico City, Mexico.
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Leyva-Alvizo A, Arredondo-Saldaña G, Leal-Isla-Flores V, Romanelli J, Sudan R, Gibbs KE, Petrick A, Soriano IS. Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery. Surg Obes Relat Dis 2019; 16:158-164. [PMID: 31839526 DOI: 10.1016/j.soard.2019.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995-2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve.
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Affiliation(s)
- Adolfo Leyva-Alvizo
- Tecnológico de Monterrey, Escuela de Medicina, Monterrey, Nuevo Leon, Mexico
| | | | | | - John Romanelli
- University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts
| | - Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Karen E Gibbs
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island University Hospital, Staten Island, New York
| | | | - Ian S Soriano
- University of Pennsylvania Perelman School of Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania.
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Flores-Villalba E, Rodriguez-Montalvo C, Bosques-Padilla F, Arredondo-Saldaña G, Zertuche-Maldonado T, Torre-Flores L. Unusual presentation of Gilbert disease with high levels of unconjugated bilirubin. Report of two cases. Rev Esp Enferm Dig 2016; 108:228-230. [PMID: 26181050 DOI: 10.17235/reed.2015.3719/2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gilbert's syndrome is a benign condition characterized by asymptomatic sporadic episodes of jaundice, due to a mild unconjugated hyperbilirubinemia caused by a deficiency in bilirubin glucoronidation. Under certain physiologic or pathologic events bilirubin level rises but according to literature it does not reach out more than 3 mg/dl. We report 2 cases of Gilbert's syndrome, genetically tested, which presented with bilirubin levels above 6 mg/dl without any trigger or coexisting condition. In conclusion, bilirubin levels higher than 6 mg/dL in Gilbert syndrome are rare, hemolytic and other metabolism diseases must be ruled out, and genetic testing may be necessary in some cases.
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Affiliation(s)
| | | | | | | | | | - Landy Torre-Flores
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Mexico
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