AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pa...AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.展开更多
AIM: To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.
AIM:To evaluate long-term survival after the Whipple operation with superior mesenteric vein/portal vein resection(SMV/PVR)in relation to resection length.METHODS:We evaluated 118 patients who underwent the Whipple op...AIM:To evaluate long-term survival after the Whipple operation with superior mesenteric vein/portal vein resection(SMV/PVR)in relation to resection length.METHODS:We evaluated 118 patients who underwent the Whipple operation for pancreatic adenocarcinoma at our Department of Hepatobiliary Pancreatic Surgery between 2005 and 2010.Fifty-eight of these patients were diagnosed with microscopic PV/SMV invasion by frozen-section examination and underwent SMV/PVR.In 28 patients,the length of SMV/PVR was≤3 cm.In the other 30 patients,the length of SMV/PVR was>3cm.Clinical and survival data were analyzed.RESULTS:SMV/PVR was performed successfully in 58patients.There was a significant difference between the two groups(SMV/PVR≤3 cm and SMV/PVR>3 cm)in terms of the mean survival time(18 mo vs 11 mo)and the overall 1-and 3-year survival rates(67.9%and14.3%vs 41.3%and 5.7%,P<0.02).However,there was no significant difference in age(64 years vs 58years,P=0.06),operative time(435 min vs 477 min,P=0.063),blood loss(300 mL vs 383 mL,P=0.071)and transfusion volume(85.7 mL vs 166.7 mL,P=0.084)between the two groups.CONCLUSION:Patients who underwent the Whipple operation with SMV/PVR≤3 cm had better long-term survival than those with>3 cm resection.展开更多
BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary...BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.展开更多
BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The...BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The diagnosis often relies on invasive manipulation,pathological examination,and molecular techniques.These difficulties in diagnosing Whipple’s disease often result in misdiagnosis and inappropriate treatments.CASE SUMMARY This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity.The results of routine blood tests indicated hypochromic microcytic anemia.Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum.A diagnosis of small intestinal adenomatosis was initially considered;hence,the Whipple procedure,a pylorus-preserving pancreaticoduodenectomy,was performed.Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum,upper jejunum,and surrounding lymph nodes.Based on comprehensive analysis of symptoms,laboratory findings,and pathological manifestations,the patient was finally diagnosed with Whipple’s disease.After receiving 1 mo of antibiotic treatment,the fatigue and anemia were significantly improved.CONCLUSION This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges,which provided new insight on the diagnosis of Whipple’s disease.展开更多
文摘AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.
文摘AIM: To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.
文摘AIM:To evaluate long-term survival after the Whipple operation with superior mesenteric vein/portal vein resection(SMV/PVR)in relation to resection length.METHODS:We evaluated 118 patients who underwent the Whipple operation for pancreatic adenocarcinoma at our Department of Hepatobiliary Pancreatic Surgery between 2005 and 2010.Fifty-eight of these patients were diagnosed with microscopic PV/SMV invasion by frozen-section examination and underwent SMV/PVR.In 28 patients,the length of SMV/PVR was≤3 cm.In the other 30 patients,the length of SMV/PVR was>3cm.Clinical and survival data were analyzed.RESULTS:SMV/PVR was performed successfully in 58patients.There was a significant difference between the two groups(SMV/PVR≤3 cm and SMV/PVR>3 cm)in terms of the mean survival time(18 mo vs 11 mo)and the overall 1-and 3-year survival rates(67.9%and14.3%vs 41.3%and 5.7%,P<0.02).However,there was no significant difference in age(64 years vs 58years,P=0.06),operative time(435 min vs 477 min,P=0.063),blood loss(300 mL vs 383 mL,P=0.071)and transfusion volume(85.7 mL vs 166.7 mL,P=0.084)between the two groups.CONCLUSION:Patients who underwent the Whipple operation with SMV/PVR≤3 cm had better long-term survival than those with>3 cm resection.
文摘BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.
文摘BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The diagnosis often relies on invasive manipulation,pathological examination,and molecular techniques.These difficulties in diagnosing Whipple’s disease often result in misdiagnosis and inappropriate treatments.CASE SUMMARY This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity.The results of routine blood tests indicated hypochromic microcytic anemia.Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum.A diagnosis of small intestinal adenomatosis was initially considered;hence,the Whipple procedure,a pylorus-preserving pancreaticoduodenectomy,was performed.Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum,upper jejunum,and surrounding lymph nodes.Based on comprehensive analysis of symptoms,laboratory findings,and pathological manifestations,the patient was finally diagnosed with Whipple’s disease.After receiving 1 mo of antibiotic treatment,the fatigue and anemia were significantly improved.CONCLUSION This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges,which provided new insight on the diagnosis of Whipple’s disease.
