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Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method  [PDF]
Theodosios Theodosopoulos,Dionysios Dellaportas,Anneza I. Yiallourou,George Gkiokas,George Polymeneas,Alexios Fotopoulos
ISRN Surgery , 2013, DOI: 10.1155/2013/960424
Abstract: Introduction. To present our experience regarding the use of pancreatic stump occlusion technique as an alternative management of the pancreatic remnant after pancreatoduodenectomy (PD). Methods. Between 2002 and 2009, hospital records of 93 patients who had undergone a Whipple's procedure for either pancreatic-periampullary cancer or chronic pancreatitis were retrospectively studied. In 37 patients the pancreatic duct was occluded by stapling and running suture without anastomosis of the pancreatic remnant, whereas in 56 patients a pancreaticojejunostomy was performed. Operative data, postoperative complications, oncological parameters, and survival rates were recorded. Results. 2/37 patients of the occlusion group and 9/56 patients of the anastomosis group were treated for chronic pancreatitis, whereas 35/37 and 47/56 patients for periampullary malignancies. The duration of surgery for the anastomosis group was significantly longer (mean time 220 versus 180 minutes). Mean hospitalization time was 6 days for both groups. The occlusion group had a lower morbidity rate (24% versus 32%). With regard to postoperative complications, a slightly higher incidence of pancreatic fistulas was observed in the anastomosis group. Conclusions. Pancreatic remnant occlusion is a safe, technically feasible, and reducing postoperative complications alternative approach of the pancreatic stump during Whipple's procedure. 1. Introduction Progress in surgical technique and perioperative management has significantly reduced the morbidity and mortality rate of pancreatic resection procedures [1, 2]. The majority of postoperative complications after pancreatoduodenectomy (PD) arise from pancreatic leakage by the pancreatic stump. The pancreatic anastomosis is called by some authors the “Achilles heel” of pancreatic surgery due to its high rate of complications among all abdominal anastomoses [3, 4]. The optimal management of the pancreatic remnant after PD remains a challenge. More than 80 different methods of pancreaticoenteric reconstruction have been described, indicating the absence of a gold standard technique [5]. An interesting alternative option is the pancreatic stump occlusion technique with various methods. Our institution’s eight-year experience using this approach in a nonselected group of patients is presented herein. The objective of our trial was to compare the two operative approaches for the management of the pancreatic remnant with regard to mean operative time, postoperative complications, oncological parameters, and one-year survival rates. 2. Materials
A. Roushan,R. Gaidarski,?V. Dimitrova,?N.Kortezova
Acta Medica Iranica , 1994,
Abstract: Several recent reports reveal that patients develop symptoms of gastorintestinal motility disorders after the standard Whipple procedure. In the Department of Propedeutics of Surgery at Bulgarian Medical Academy in Sofia we observed the same phenomenon in our Whipple-operated group of patients. But the pathogenetic mechanism was so far unclear that prompted us to conduct an experimental study in this area. Eight mongrel dogs weighing an average weight of 15-20 Kg were operated after a Whipple procedure; five dogs survived postoperatively. Microelectrodes were implanted subserously on the muscular wall of the gastric remnant, afferent and efferent loop of the jejunum, as well as in the duodenum which were kept intact to serve the purpose. Bioelectric tracings were conducted twice or thrice weekly for a period of 2-3 hours up to the end of the first postoperative year. Serious rhythmic as well as characteristic disturbances which are believed to be related to the motility disorders after this operative procedure were found in the bioelectric activity of the gastric remnant.
Management of the pancreatic remnant during Whipple operation
Setzis K.,Barbetakis N.,Theodosiou A.,Chatzigeorgiou N.
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Pancreaticojejunostomy is the most frequent site of fistula formation in patients undergoing Whipple procedure (pancreaticoduodenectomy). The results of an end-to-side anastomosis of the pancreatic stump to the jejunum are discussed in this retrospective review of 21 patients who underwent Whipple procedure for cancer of the pancreas or periampullary region. Key words: Whipple procedure, pancreaticojejunostomy, pancreaticojejunal fistula
Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial  [cached]
Gang Wang,Zhi-Wei Jiang,Jing Xu,Jian-Feng Gong
World Journal of Gastroenterology , 2011,
Abstract: AIM: To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS: One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded.RESULTS: The restoration time of gastrointestinal functions in the patients was significantly faster after fast-track rehabilitation program than after conventional care (2.1 d vs 3.2 d, P < 0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P < 0.05). Also, the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P < 0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P < 0.01). No significant difference was observed in the re-admission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%).CONCLUSION: The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.
ChroPac-Trial: Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial
Markus K Diener, Thomas Bruckner, Pietro Contin, Christopher Halloran, Matthias Glanemann, Hans Schlitt, Joachim M?ssner, Meinhard Kieser, Jens Werner, Markus W Büchler, Christoph M Seiler
Trials , 2010, DOI: 10.1186/1745-6215-11-47
Abstract: ChroPac aims to investigate differences in quality of life, mortality and morbidity during 24 months after surgery (duodenum-preserving pancreatic head resection versus pancreatoduodenectomy) in patients with chronic pancreatitis of the pancreatic head.ChroPac is a randomised, controlled, observer and patient blinded multicentre surgical trial with two parallel comparison groups. The primary outcome measure will be the average quality of life during 24 months after surgery. Statistical analysis is based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison adjusting for age, centre and quality of life before surgery. Level of significance is set at 5% (two-sided) and sample size (n = 100 per group) is determined to assure a power of 90%.The ChroPac trial will explore important outcomes from different perspectives (e.g. surgeon, patient, health care system). Its pragmatic approach promises high external validity allowing a comprehensive evaluation of the surgical strategy for treatment of patients with chronic pancreatitis.Controlled-trials.com ISRCTN38973832Chronic pancreatitis (CP) is defined as a continuous inflammatory process causing permanent structural damage ultimately resulting in impairment of the gland's exocrine and endocrine function [1,2]. The most important causative agent is alcohol. Patients with CP who present with inflammatory pancreatic head enlargement, commonly require pancreatic head resection due to development of local complications (e. g. stenosis of the common bile duct and/or main pancreatic duct, duodenal obstruction, compression of retropancreatic vessels), suspicion of malignancy, and most commonly intractable pain [3,4]. Pancreatoduodenectomy (PD), i.e. the classical Whipple (CW) and subsequently the pylorus-preserving Whipple (PPW) procedure has served as primary surgical procedures for removal of the pancreatic head in patients with CP and pancreatic head enlargement for ma
Synchronous Hepatic Cryotherapy and Resection of Colonic Primary is a High Risk Procedure  [PDF]
D. Cheung,D. L. Morris
HPB Surgery , 2000, DOI: 10.1155/2000/60432
Abstract: Thirteen patients underwent hepatic cryotherapy and synchronous colonic resection. Two of the nine patients developed hepatic abscess – this is a rare complication of cryotherapy alone.
Enucleation of a large true cyst in the head of pancreas instead of Whipple procedure in an 8-year old boy: a case report
Ostadian N,Mirrokni SM,Noorzadeh M
Tehran University Medical Journal , 2011,
Abstract: "nBackground: Simple cysts of pancreas are smaller than complex ones and are more likely to be located at the distal tail of the pancreas. Simple cysts are often asymptomatic and can be managed conservatively by observation. There seems to be few clinical trials to suggest the best treatments method for large symptomatic cysts of pancreas located at the head of the organ."n "nCase presentation: In this report, we describe an eight-year old boy with a large symptomatic true cyst at the head of the pancreas who was successfully treated by enucleation of the cyst, instead of the Whipple's procedure, without any ensuing complications."n "nConclusion: Regarding the rarity of simple cysts in the pancreas, lack of studies to compare different surgical procedures and suggest the best methods to treat them and the considerable morbidity and even mortality of major surgeries (e.g Whipple's procedure) enucleation of these cysts seem to be appropriate for treating them with no early or late complications. More studies are needed to warrant the results of this report.
A Bayesian track-before-detect procedure for passive radars
Khalil Jishy and Frederic Lehmann
EURASIP Journal on Advances in Signal Processing , 2013, DOI: 10.1186/1687-6180-2013-45
Abstract: This article presents a Bayesian algorithm for detection and tracking of a target using the track-before-detect framework. This strategy enables to detect weak targets and to circumvent the data association problem originating from the detection stage of classical radar systems. We first establish a Bayesian recursion, which propagates the target state probability density function. Since raw measurements are generally related to the target state through a nonlinear observation function, this recursion does not admit a closed form expression. Therefore, in order to obtain a tractable formulation, we propose a Gaussian mixture approximation. Our targeted application is passive radar, with civilian broadcasters used as illuminators of opportunity. Numerical simulations show the ability of the proposed algorithm to detect and track a target at very low signal-to-noise ratios.
Doen?a de Whipple
Oliveira,Luís; Gorj?o,Ricardo; Deus,Jo?o Ramos de;
Jornal Português de Gastrenterologia , 2010,
Abstract: the authors review the entity known as whipple?s disease, describing its epidemiology and clinical presentation, discussing and updating recent advances relevant to its diagnostic and therapeutic management. whipple?s disease is a rare, chronic bacterial illness, with multisystemic involvement, caused by a gram-positive bacillus, tropheryma whipplei, of the actinobacterias family and actinomycetes group. due to its multiform presentation and rarity it is often misdiagnosed and warrants close follow-up to assess therapeutic response.
Evaluación y seguimiento de los pacientes sometidos a operación de Whipple o duodenopancreatectomía cefálica en un hospital de IV nivel de Medellín Evaluation and follow-up of patients undergoing the Whipple procedure (cepahalic pancreatoduodenectomy) at a level IV of care hospital in Medellín Colombia
Sergio Hoyos,álvaro Duarte,Gloria Franco,Jaime Chávez
Revista Colombiana de Cirugía , 2012,
Abstract: Objetivo. Evaluar las indicaciones, resultados y supervivencia de los pacientes sometidos a duodenopancreatectomía cefálica en el Hospital Pablo Tobón Uribe de Medellín. Pacientes y métodos. Se incluyeron todos los pacientes sometidos a duodenopancreatectomía cefálica (operación de Whipple), desde abril de 2004 hasta abril de 2011. La información se obtuvo de la base de datos prospectiva de la Unidad de Cirugía Hepato-Biliar y Pancreática del Hospital Pablo Tobón Uribe. Resultados. Se operaron 68 pacientes, con una edad promedio de 59 a os (rango, 16-82) y 50 % eran hombres. La principal indicación de la cirugía fue neoplasia maligna (97 %), con la siguiente distribución: adenocarcinoma pancreático, 25 pacientes (36,7 %); carcinoma ampular, 23 (33,8 %); colangiocarcinoma distal, 8 (11,7 %) cáncer de duodeno, 4 (5,8 %), y 8 (11,7 %) tuvieron otras indicaciones. El sangrado operatorio en promedio fue de 455 ml (rango, 200 a 2.000 ml); 5,8 % de los pacientes sangraron 1.000 ml o más; en 35,2 % de los casos se requirió transfusión de glóbulos rojos, con un rango entre 1 y 8 unidades; 5,8 % de los pacientes requirió cinco o más unidades de glóbulos rojos. El rango de estancia en la unidad de cuidados intensivos fue 1 a 20 días, con un promedio de 2 días; 45,5 % de los pacientes estuvo en la unidad de cuidados intensivos un solo día. Se presentaron complicaciones en el 33,8 % de los pacientes, y las más comunes fueron atonía gástrica, infección distante al sitio operatorio, infección del sitio operatorio y sangrado posoperatorio. La mortalidad posoperatoria a 30 días fue de 14,7 % en toda la serie; al hacer un análisis del último grupo de 25 pacientes, la cifra bajó a 8 %, con una supervivencia actuarial de toda la serie de pacientes de 54,4 %. Conclusión. En nuestro hospital, la duodenopancreatectomía cefálica sigue teniendo alta mortalidad en comparación con algunos centros de referencia en el mundo, aunque es evidente que ha mejorado en los últimos a os; las cifras de morbilidad están acordes a las reportadas en diferentes series mundiales de excelencia. Introduction: Objective: To evaluate the indications, results and survival of patients undergoing pancreatoduodenectomy at Hospital Pablo Tobon Uribe of Medellin. Materials and methods: We collected all patients that underwent pancreatoduodenectomy (Whipple operation), from April 2004 to April 2011. The information was obtained from a prospective database from the Hepato-Biliary and Pancreatic Unit of Hospital Pablo Tobón Uribe. Results: 68 patients were operated in total, with an average age of 59 years (1
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