ABSTRACT
Background: There is no gold standard method for pancreatico-enteric reconstruction. In our department, dunking pancreatojejunostomy (DPJ) and Duct to mucosa PJ technique are done as per surgeon’s choice. In this study, authors evaluate the early postoperative outcomes following DPJ based on ISGPS (2007).Methods: A Retrospective analysis of prospectively collected data from January 2008 to December 2015. Detailed information on these patients was maintained on a prospectively held computerized database. Routine drain amylase estimations are being done on POD 3and 5 for all patients undergoing pancreatic resections and on all subsequent days if output is suggestive of pancreatic fistula. Details of patients who have undergone pancreatic resection with duct to mucosa type of pancreato-intestinal anastomosis during the same period (64 patients) were also collected prospectively and analysed. DPJ and Duct to mucosa groups were not comparable with respect to age, duct size, pancreatic gland texture and co-morbidities. Hence direct comparison between the two groups has not been carried out.Results: A total of 75 of 139 pancreatic resections with pancreatointestinal anastomosis who had dunking PJ and fulfilled the study criteria were analysed; none were excluded for analysing early outcomes. 19 out of 75 (25.5%) developed grade ‘A’ POPF, five out of 75 (6.6%) developed Grade ‘B’ POPF and three out of 75 (3.3%) developed Grade ‘C’ POPF. 20 out of 75 (26.6%) had grade ‘A’ DGE, five out of 75 (6.6%) had grade ‘B’ DGE. PPH occurred in four out of 75 (5.3%), two out of four were early PPH, one was managed by coiling and other by re-laparotomy, two were late PPH both managed by coiling of the pseudo aneurysms. There was no 30-day mortality.Conclusions: Dunking (Invagiantion) pancreatojejunostomy has accepatable early outcomes with clinically significant/relevant postoperative pancreatic fistula rates of Grade B (6.6%) and Grade C (4%), delayed gastric emptying (33.2%) and post pancreatic hemorrhage (5.3%) rates. The outcomes are comparable with Duct-to-mucosa PJ mentioned in literature.
ABSTRACT
Low birth weight (LBW) is a significant indicator of child survival and future morbidity in any community all over the world. It has reduced considerably in developing countries due to improved living conditions and better care of women and adolescent girls. However, in developing countries, it is still an important cause of child mortality and morbidity. LBW is typically multifactorial at different levels such as maternal, fetal, and environmental factors. Objectives: The objectives are as follows: (1) To assess the prevalence of LBW in a tertiary care setting in a rural area and (2) to determine various sociodemographic factors associated with LBW and degree of association of each. Materials and Methods: A record based study was conducted at Adichunchanagiri Hospital and Research Centre, wherein all singleton live births data for 1 year (January 1, 2016–December 31, 2016) were accessed from the MRD section of AH and RC. All available data were analyzed using percentages, odds ratio, and Multivariate analysis. Results: Overall, the prevalence of LBW was 15.89% (194 LBW out of 1221 live births). Female babies (17.12%), Teenage mothers (19.37%), Rural residence (15.94%), Maternal Hypertension (21%), and Shorter spacing between pregnancies (17.47%), and Preterm (62%) were some associated factors with LBW. Of all the above risk factors, teenage mothers, spacing, and gestational age were found to be statistically significantly associated with LBW. Conclusions: Although declining in most communities, LBW still remains unacceptably high in many undeveloped regions. It requires a multi-pronged approach by a team of dedicated professionals to reduce this problem afflicting mankind.