ABSTRACT
Objective:To investigate the application value of laparoscopic pancreatic tumor enucleation (LapEN).Methods:The retrospective and descriptive study was conducted. The clinical data of 47 patients who underwent LapEN in Second Hospital of Hebei Medical University from September 2016 to June 2022 were collected. There were 18 males and 29 females, aged (49±12)years. Observa-tion indicators: (1) surgical situations; (2) postoperative complications; (3) postoperative recovery; (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All 47 patients underwent LapEN successfully, with the operation time as (135±19)minutes and the volume of intraoperative blood loss as 100(50,100)mL. (2) Postoperative complications. Of the 47 patients, there were 12 patients with postoperative pancreatic fistula, 3 patients with postoperative abdominal infection, 1 case with postoperative hemorrhage, 1 case with postoperative gastric emptying disorder. (3) Postoperative recovery. Of the 47 patients, there were 13 cases with pancreatic solid pseudopapillary neoplasm, 12 cases with insulinoma, 11 cases with pancreatic serous cystadenoma, 7 cases with pancreatic intraductal papillary mucinous neoplasm (branched type), 4 cases with pancreatic mucinous cyst-adenoma. The tumor diameter of 47 patients was 1.9(1.6,2.3)cm and all patients with R 0 resection. There was no patient with perioperative death in the 47 patients. The postoperative duration of hospital stay and total hospital expenses of 47 patients was (13±4)days and (6.8±1.2) ten thousand yuan, respectively. (4) Follow-up. All 47 patients were followed up for 14(range, 8?18)months. None of the 47 patients had new onset diabetes or situations required postoperative exocrine replacement therapy, and no patient died. Conclusion:LapEN is safe and feasible for patients with pancreatic benign tumor or low potential malignancy.
ABSTRACT
Postoperative pancreatic fistula (POPF) is a common complication and the main leading cause of death after pancreaticoduodenectomy (PD). In recent years, with the deepening of people's understanding of acute pancreatitis (AP) after pancreatic surgery, more and more evidence shows that AP is another common complication which is different from POPF after PD. AP is an independent risk factor for the occurrence and development of POPF, and is closely related to serious complications such as infection and death. The establishment of the concept of AP after PD makes people have a more comprehensive understanding of the pathophysiological changes of residual pancreatic tissue in the early stage after PD, and further understanding of the occurrence and development mechanism of POPF, and have more thoughts on the prevention and treatment measures of AP and POPF after PD, which will further enhance clinical management level and safety after PD.
ABSTRACT
Background: Pancreatic surgeries have undergone substantial changes over the last few decades and are now being attempted by many surgeons not limited to specialised centres. The study has attempted to document the indications for elective pancreatic surgeries and its outcomes in terms of morbidity and mortality.Methods: This observational study included 42 patients over a period of 12 months. The data were recorded in a predesigned proforma to assess the indication for elective pancreatic surgery, to describe the number and kind of pancreatic operation undertaken and to evaluate the short-term outcome of various pancreatic surgeries in terms of complications, morbidity and mortality.Results: Authors studied 42 patients, who underwent the elective pancreatic surgeries for various indications in hospital. Histopathological studies revealed that the majority (50%) were carcinoma of the head of pancreas. Pancreaticoduodenectomy (PD) was done in all the sixteen cases. The most important complications of PD were delayed gastric emptying (DGE) (50%), surgical site infection (SSI) (43.7%), post pancreatic haemorrhage (PPH) (31%), post-operative pancreatic fistula (POPF) (25%) and intra-abdominal abscess (IAA) (12.5%). Of the 26 patients operated for benign conditions of pancreas, 19 (73%) had pancreatic pseudocyst, in majority of cases as a sequela of alcohol induced pancreatitis. Partington Rochelle procedure was the commonest surgical procedure in chronic pancreatitis.Conclusions: Carcinoma of head of pancreas was the most common periampullary malignancy necessitating major pancreatic resections. DGE, POPF and PPH were the most common and significant post-operative complications.
ABSTRACT
PURPOSE: Leakage of pancreatico-jejunal anastomosis (PJ) remains the primary cause of morbidity and mortality after Whipple's operation. To reduce the occurrence thereof, the present author recently began to apply a modification of the Blumgart method of anastomosis after Whipple's operation (hereinafter referred to as Lee's method), with very good results. MATERIALS AND METHODS: The modified method and technique utilizes fish-mouth closure of a beveled pancreatic stump and parachuting of the pancreatic end with double U trans-pancreatic sutures (symmetric horizontal mattress-type sutures between the full thickness of the pancreas and the jejunal limb) after duct-to-mucosa pancreatico-jejunostomy. RESULTS: Eleven cases of pylorus preserving Whipple's operation have been performed without a clinically significant postoperative pancreatic fistula. CONCLUSION: This new method (Lee's method) may dramatically reduce the occurrence of postoperative pancreatic fistula after Whipple's operation.