Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy for carcinoma of the head of the pancreas, randomized study

Pancreaticoduodenectomy is the primary means of treating cancer head of the pancreas. Associated mortality rates have dropped dramatically in the past decade, but morbidity rates remain high. Patients were divided randomly into two groups:- 1- The first group includes 49 patients have undergone pancreaticogastrostomy. 2- The second group includes 55 patients have undergone pancreaticojejunostomy. The patients were followed for the presence of complications especially pancreatic leak. The study included 104 patients divided randomizly into two groups the first group included 49 patients who had undergone pancreaticogastrostomy and the other group includes 55 patients who had undergone pancreaticojejunostomy. 70% were males, 30% were females, age 74 +/- 13 years. Comparing the complication observed after the two procedures, Multiple complications occurred in 30.6% in patients who undergone pancreaticogastrostomy and 38.18% in patients who undergone pancreaticojejunostomy. With no statistically significant difference between the 2 procedures. No reported mortality in the two groups had been observed. The most common complication observed in the pancreaticogastrostomy group was pancreatic fistula [14.28%] followed by intra-abdominal fluid [8.16%], biliary fistula, bleeding, reoperation [4.08%] each. For the pancreaticojejunostomy group the most common complication observed were pancreatic fistula [20%] followed by intra-abdominal fluid and reoperation [9.09%] each, biliary fistula [5.45%], no bleeding reported. pancreaticogastrostomy is associated with a lower frequency of multiple surgical complications which is not statistically significant and higher incidence of pancreatic fistula in the pancreaticojejunostomy arm

Total cystopericystectomy versus traditional cyst evacuation for treatment of hydatid cysts of the liver

Echinococcosis is a zoonotic disease that occurs throughout the world. Surgery is the recommended treatment for hepatic hydatid cysts. The purpose of this study is to evaluate the technique of cystopericystectomy for treatment of hydatid cysts of the liver comparing it with the traditional surgical technique of cyst evacuation. Twenty six patients [26] admitted with hydatid disease of the liver in Assiut University Hospital from January 2004 to April 2007. All patients were randomized into two groups, group I [13 patients] were managed by total cystopericystestomy and group II [13 patients] managed by conservative technique of cyst evacuation. History, clinical examination chest X-ray abdominal ultrasonography and computed tomography were performed. All patients were treated with oral albendazole dose for two months after surgery. Blood transfusion hospital stay, post-operative complications, and any evidence of hydatid recurrence were recorded. Surgery was performed on 26 patients with liver hydatid disease [14 men and 12 women] with a mean age of 40.2 years [range 21-73 years]. The mean diameter of the cyst was 6.6cm [range 5-11cm]. Blood transfusion was required in 5 patients in the group of cystopericystectomy and in 2 patients of traditional technique of cyst evacuation. The mean hospital stay was 6.1 days in cystopericystectomy group and 8.2 days in the traditional technique of cyst evacuation. During the follow up period which extended up two years postoperatively, no mortality was verified, the incidence of postoperative complications was 7.6% in the group randomized to cystopericystectomy and it was 23.07% in the group randomized to cyst evacuation. Recurrence of hydatid disease was observed in one patient 7.6% in the group treated by cyst evacuation, but no recurrence was observed in cystopericystectomy group. Surgical treatment of hepatic hydatid disease by total cystopericystectomy combined with medical therapy with albendazole is a valuable alternative to the more conservative technique of cyst evacuation with a lower incidence of morbidity and recurrence