Pancreatic fistula and mortality after surgical management of pancreatic trauma: analysis of 81 consecutive patients during 11 years at a Korean trauma center

PURPOSE: Pancreatic trauma is infrequent because of its central, deep anatomical position. This contributes to a lack of surgeon experience and many debates exist about its standard care. This study aimed to investigate the postoperative pancreatic fistula (POPF) and mortality of pancreatic trauma after operation. METHODS: We reviewed records in the trauma registry of our institution submitted from January 2006 to December 2016. The grade of pancreatic injury, surgical management, morbidity, mortality, and other clinical variables included in the analyses. RESULTS: Data from a total of 26,072 trauma patients admitted to the Emergency Department were analyzed. Pancreatic trauma was observed in 114 of these patients (0.44%). Laparotomy was performed in 81 patients (2 pan creatico duodenectomies, 2 pancreaticogastrostomies, peripancreatic drainage in 41 patients, distal pancreatectomies in 34 patients, and 9 patients who underwent surgery for damage control). The incidence of POPF was 38.3%. The overall mortality was 8.8% (7 of 81). In multivariate analysis, pancreas injury grade IV (≥4) (adjusted odds ratio [AOR], 4.071; P = 0.029) and preoperative peritonitis signs (AOR, 2.903; P = 0.039) were independent risk factors for POPF. All patients who died had also another major abdominal injury (≥grade 3). Multiorgan failure was a major cause of death (6 of 7, 85.7%). The mortality rate of isolated pancreas injury was 0%. CONCLUSION: The pancreas injury grade and preoperative peritonitis were significant risk factors of POPF. The mortality rate of isolated pancreatic trauma was very low.

Early postoperative small bowel obstruction after laparotomy for trauma: incidence and risk factors

PURPOSE: This study aimed to investigate the incidence and risk factors of early postoperative small bowel obstruction (EPSBO) after laparotomy for trauma patients. METHODS: From 2009 to 2016, consecutive patients who had undergone laparotomy for trauma were retrospectively evaluated. EPSBO was defined as the presence of signs and symptoms of obstruction between postoperative days 7 and 30, or obstruction occurring anytime within 30 days and lasting more 7 days. RESULTS: Among 297 patients who met the inclusion criteria, 72 (24.2%) developed EPSBO. The length of hospital stay was significantly longer in patients with EPSBO than in those without EPSBO (median [interquartile range], 34 [21–48] days 24 [14–38] days, P < 0.001). Multivariate logistic analysis identified male sex (adjusted odds ratio [AOR], 3.026; P = 0.008), intraoperative crystalloid (AOR, 1.130; P = 0.031), and Abbreviated Injury Scale (AIS) score for mesenteric injury (AOR, 1.397; P < 0.001) as independent risk factors for EPSBO. The incidence of adhesive small bowel adhesion after 30 days postoperatively did not significantly differ between the 2 groups (with EPSBO, 5.6% without EPSBO, 5.3%; P = 0.571). Most of the patients with EPSBO were recovered by conservative treatment (95.8%). CONCLUSION: After laparotomy for trauma patients, the incidence of EPSBO was 24.2% in our study. EPSBO was associated with a longer hospital stay. Male sex, use of intraoperative crystalloid, and AIS score for mesenteric injury were significant independent risk factors for EPSBO. Patients with these risk factors should be followed-up more carefully.

Therapeutic Options in Patients with Traumatic Splenic Injury

PURPOSE: Splenic injury management has shifted to non-surgical treatment to preserve the spleen because of the postoperative risks of overwhelming post-splenectomy infection. In this study, we analyzed risk factors of therapeutic options for splenic injury, using medical records of Chonnam National University Hospital. METHODS: We reviewed the medical records of 110 consecutive patients with traumatic splenic injuries admitted from January 2009 to December 2013. Demographic characteristics and therapeutic options such as conservative treatment, angiographic embolization and emergency operation and clinical parameters were analyzed in this study. RESULTS: Thirty-four patients were treated surgically and seventy-six were managed with nonsurgical treatment. Multivariate logistic regression identified age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.009~1.072; p=0.01), hematocrit (OR, 0.878; 95% CI, 0.806~0.957; p=0.003), contrast extravasation (OR, 7.644; 95% CI, 2.248~25.986; p=0.001), spleen grade (OR, 2.08; 95% CI, 1.128~ 3.836; p=0.019) as significant risk factors of emergent splenectomy. CONCLUSION: Age, hematocrit, contrast extravasation, spleen grade were significant risk factors for emergent splenectomy.

Damage Control Surgery Following Endovascular Management in a Patient with Psoas Muscle Penetrating Injury

No abstract available.

Damage Control Surgery with Negative Pressure Wound Theraphy for Impalement Injury of Pelvic and Periproctal Wound

No abstract available.

A Clinical Analysis of Endoscopic Thyroidectomy via Bilateral Axillo-breast Approach: A 5-year Experience / 대한내분비외과학회지

PURPOSE: We investigated the efficacy and safety of endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) by analyzing short term surgical outcomes. METHODS: We retrospectively evaluated 355 patients who underwent BABA endoscopic thyroidectomy between August 2006 and December 2011 at Chonnam National University Hospital and Hwasun Chonnam National University Hospital. The age, sex, clinical and pathologic characteristics of tumors, extent of operation, conversion rate to open thyroidectomy, operation time, hospital stay, thyroglobulin levels after thyroidectomy, recurrence, and complications were analyzed retrospectively. RESULTS: The mean age of the patients was 35 years. The 355 patients comprised 345 females (97.2%) and 10 males (2.8%). The benign tumor was 37 cases (10.4%) and the malignant tumor was 318 cases (89.6%). 28 patients (75.7%) of the benign tumor underwent lobectomy. In malignant tumor, 159 patients (50.0%) underwent lobectomy and 152 patients (47.8%) underwent total thyroidectomy. Mean operation time was 121.1+/-49.9 minutes, and mean hospital days were 3.4+/-1.1 days. 21 (6.0%) transient hypocalcemia and 7 (2.0%) permanent hypocalcemia were occurred. The transient voice change occurred in 5 patients (1.4%), but nobody suffered from the permanent recurrent laryngeal nerve injury. 4 patients of recurrent (1.3%) papillary thyroid carcinoma were treated by surgery. CONCLUSION: Compare to open thyroidectomy with long term follow up studies, BABA endoscopic thyroidectomy is a useful treatment option for both benign and malignant thyroid tumor.

The Clinical Outcome of Laparoscopic Common Bile Duct Exploration for the Primary Treatment of Choledocholithiasis

PURPOSE: For choledocholithiasis, many doctors routinely use ERCP/EST to avoid the need for common bile duct exploration. But, ERCP/EST has some weakpoints. So it may not be a first choice for management, especially in secondary hospitals. Therefore, we investigated and reviewed results of LCBDE as a first treatment for common bile duct stones. METHODS: This study was a retrospective analysis of 60 cases that could be reviewed by their medical charts and who underwent LCBDE performed by the same surgeon at the Yeosu Chonnam Hospital between March, 1996 and August, 2009. The clinical data were compared between each two groups (1996~1999 vs 2000~2009 years, primary closure vs T tube drainage). RESULTS: Between groups A and B, there were no significant differences in preoperative status of the patient except for age (60.5 vs 72.6). The average operative time was decreased in group B (171.6 mins vs 143.0 mins) and the number of trocars was decreased in group B (4 vs 3.2). There were 13 postoperative complications. Among them, 11 were cases of bile leakage. All of the bile leakage cases were in group B. And there were more bile leakages in the primary repair group than in T tube drainage group (50% vs 8.9%). But, 10 cases of bile leakage were improved completely by observation and conservative treatment. CONCLUSION: LCBDE is a safe and useful treatment that has several advantages and can overcome problems not solved by ERCP. Fatal complications were not increased in the primary repair group compared with the T tube drainage group.