Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 39
Filter
1.
Rev. cir. (Impr.) ; 72(5): 460-463, oct. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1138739

ABSTRACT

Resumen Introducción: El tumor sólido pseudopapilar del páncreas es una rara entidad que representa menos del 1% de las neoplasias pancreáticas. Suele presentarse en mujeres jóvenes y solo da síntomas de carácter compresivo una vez que alcanza un gran tamaño. Dado su comportamiento biológico incierto el tratamiento es la cirugía. Caso Clínico: Presentamos el caso de una mujer de 23 años con historia de 1 año de evolución de dolor epigástrico y baja de peso. El estudio imagenológico demostró una masa heterogénea sólida-quística dependiente de la cabeza del páncreas de aspecto neoplásico. Se realizó una biopsia incisional laparoscópica cuyo resultado fue de un tumor maligno indiferenciado, por lo que se optó por la resección quirúrgica. Se realizó una pancreatoduodenectomía abierta sin incidentes con un postoperatorio favorable. Los análisis histopatológicos e inmunohistoquímico fueron compatibles con un tumor sólido pseudopapilar de páncreas.


Introduction: The pseudopapillary solid tumor of the pancreas is a rare entity that represents less than 1% of pancreatic neoplasms. It usually occurs in young women and only gives symptoms of a compressive nature once it has reached a large size. Given its uncertain biological behavior, the treatment is surgery. Case Report: We present the case of a 23-year-old woman with a 1-year history of epigastric pain evolution and weight loss. The imaging study demonstrated a solid-cystic heterogeneous mass dependent on the head of the pancreas of neoplasic appearance. A laparoscopic incisional biopsy was performed, the result of which was an undifferentiated malignant tumor, which was why the surgical resection was chosen. An open pancreatoduodenectomy was performed without incident with a favorable post operative. Histopathological and immunohistochemical analyzes were compatible with a solid pseudopapillary tumor of the pancreas.


Subject(s)
Humans , Female , Young Adult , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Pancreatic Neoplasms/diagnostic imaging , Magnetic Resonance Spectroscopy , Tomography , Ultrasonography
2.
Rev. bras. anestesiol ; 70(4): 343-348, July-Aug. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137196

ABSTRACT

Abstract Purpose: This study aimed to investigate factors associated with postoperative Acute Kidney Injury (AKI) focusing on intraoperative hypotension and blood loss volume. Methods: This was a retrospective cohort study of patients undergoing pancreas surgery between January 2013 and December 2018. The primary outcome was AKI within 7 days after surgery and the secondary outcome was the length of hospital stay. Multivariate analysis was used to determine explanatory factors associated with AKI; the interaction between the integrated value of hypotension and blood loss volume was evaluated. The differences in length of hospital stay were compared using the Mann-WhitneyU-test. Results: Of 274 patients, 22 patients had experienced AKI. The cube root of the area under intraoperative mean arterial pressure of < 65 mmHg (Odds Ratio = 1.21; 95% Confidence Interval 1.01-1.45; p = 0.038) and blood loss volume of > 500 mL (Odds Ratio = 3.81; 95% Confidence Interval 1.51-9.58; p = 0.005) were independently associated with acute kidney injury. The interaction between mean arterial hypotension and the blood loss volume in relation to acute kidney injury indicated that the model was significant (p < 0.0001) with an interaction effect (p = 0.0003). AKI was not significantly related with the length of hospital stay (19 vs. 28 days, p = 0.09). Conclusion: The area under intraoperative hypotension and blood loss volume of > 500 mL was associated with postoperative AKI. However, if the mean arterial pressure is maintained even in patients with large blood loss volume, the risk of developing postoperative AKI is comparable with that in patients with small blood loss volume.


Resumo Justificativa: O presente estudo teve como objetivo examinar os fatores associados à Lesão Renal Aguda (LRA) no pós-operatório, centrando-se na hipotensão e perda de sangue intraoperatórias. Método: Estudo de coorte retrospectivo de pacientes submetidos a cirurgia de pâncreas entre Janeiro de 2013 e Dezembro de 2018. O desfecho primário foi ocorrência de LRA em até 7 dias após a cirurgia e o secundário, o tempo de hospitalização. A análise multivariada foi usada para determinar os fatores explicativos associados à LRA; a interação entre o valor integrado da hipotensão e volume de perda de sangue foi avaliada. As diferenças no tempo de hospitalização foram comparadas pelo teste U de Mann-Whitney. Resultados: Dos 274 pacientes, 22 pacientes apresentaram LRA. A raiz cúbica da área sob a pressão arterial média intraoperatória < 65 mmHg (Odds Ratio = 1,21; Intervalo de Confiança de 95% 1,01-1,45; p = 0,038) e volume de perda sanguínea > 500 mL (Odds Ratio = 3,81; Intervalo de Confiança de 95% 1,51-9,58; p = 0,005) estavam independentemente associados à lesão renal aguda. A interação entre hipotensão arterial média e volume de perda sanguínea em relação à lesão renal aguda apontou o modelo como significante (p < 0,0001) com efeito de interação (p = 0,0003). A LRA não apresentou relação significante com o tempo de hospitalização (19 vs. 28 dias, p = 0,09). Conclusões: A área sob hipotensão arterial e o volume de perda sanguínea > 500 mL no intraoperatório apresentaram associação com LRA no pós-operatório. Entretanto, se a pressão arterial média se mantém, mesmo em pacientes com grande volume de perda sanguínea, o risco de desenvolver LRA no pós-operatório é comparável ao risco dos pacientes com pequeno volume de perda sanguínea.


Subject(s)
Humans , Male , Female , Aged , Postoperative Complications/epidemiology , Blood Loss, Surgical , Acute Kidney Injury/epidemiology , Hypotension/complications , Pancreatectomy/methods , Retrospective Studies , Risk Factors , Cohort Studies , Pancreaticoduodenectomy/methods , Acute Kidney Injury/etiology , Arterial Pressure , Intraoperative Complications/physiopathology , Length of Stay , Middle Aged
3.
Prensa méd. argent ; 106(1): 10-16, 20200000. graf, fig
Article in English | LILACS, BINACIS | ID: biblio-1369693

ABSTRACT

Antecedentes: La duodenopancreatectomía cefálica (D.P.C.) es el procedimiento quirúrgico aceptado para el tratamiento de los tumores malignos y benignos del confluente bilio-duodenopancreático. Lugar de aplicación: hospital nacional de clínicas y clínica privada. Diseño: estudio protocolizado y prospectivo. Material y método: entre diciembre 2000 y diciembre 2014 se operaron 96 dpc. De ellos, 54 del sexo masculino y 42 del femenino, cuyas edades oscilaron entre 27 y 79 años de edad (media de 59 años). El promedio del período de tiempo entre el inicio de los síntomas y la primera consulta fue de 81 días (rango 10 a 129 días). A todos los pacientes se les llevo a cabo ecografía y tac de abdomen. Resultados: con respecto a la mortalidad dentro de los 30 días, fallecieron 5 pacientes (4, 80 %). Posteriormente, fallecieron dentro de los 90 días 5 pacientes más (9,3 %). Con respecto a la morbilidad, las dividimos en clínicas que fueron 17 pacientes (16,32 %) y 50 fueron quirúrgicas (48 %). Dentro de ellas la fistula pancreática estuvo en 32 pacientes (30,72 %). Con respecto al vaciamiento gástrico estuvo presente en 19 (18,24 %) y finalmente 5 (4,80 %) tuvieron una hemorragia intra peritoneal. Ocho pacientes tuvieron una fistula biliar (7,62 %). Conclusiones: los resultados de nuestro trabajo, apoyan el concepto que cirujanos con bajo volumen de d.P.C. Anuales, pero con una estricta formación en instituciones con infraestructura adecuada y un equipo multidisciplinario, pueden también obtener buenos resultados en las lesiones malignas y benignas del confluente bilio-duodeno-pancreático


Background: Cephalic pancreatoduodenectomy (CPD) is the surgical procedure of choice accepted for the management of both the malignant and the benign tumors of the bilio- duodeno pancreatic confluence. Setting: Clinico- National Hospital and private practice. Desing: protocoled and prospective study. Methods: between december 2000 and december 2014, 96 cpd have been operated. Of these, 54 were men and 42 were women, with ages ranged between 27 to 79 years (average 59 years). The time between the onset of symptoms and the first consultation period. Averaged 81 days (range 10-129 days). All the patients were submitted to ultrasound and ct of the abdomen. Results: with reference to mortality within 30 days, 5 patients (4, 80%) died. Subsequently, 5 more patients died within 90 days (9.3%). With reference to morbidity, we divided them in two, clinicals that were 17 patients (16.32%) And 50 were surgical (48%). Within pancreatic fistula included 32 patients (30, 72%). With reference to the gastric emptying, it was present in 19 (18.24%) And finally 5 (4.80%) Had intra peritoneal bleeding. In addition, 8 patients had a biliary fistula (7.62%). Conclusions: the results of our study support the concept that surgeons with low volume of cpd annually, but with strict training in institutions with adequate infraestructure and a multidisciplinary team, can also obtain good results in the malignant and benign lesions of the biliary-duodeno-pancreatic confluence.


Subject(s)
Humans , Adult , Middle Aged , Aged , Pancreatic Neoplasms/surgery , Surgical Procedures, Operative/methods , Morbidity , Mortality , Ultrasonography , Pancreaticoduodenectomy/methods , Gastric Emptying
4.
Rev. Col. Bras. Cir ; 47: e20202501, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136552

ABSTRACT

ABSTRACT Objective: the first robotic pancreatic resection in Brazil was performed by our team in 2008. Since March 2018, a new policy prompted us to systematically employ the robot in all minimally invasive pancreatic surgery. The aim of this paper is to review our experience with robotic pancreatic resection. Methods: all patients who underwent robotic pancreatic resection from March 2018 through December 2019 were identified. Descriptive data were collected. Preoperative variables included age, sex, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Results: 105 patients underwent robotic pancreatectomy. Median age was 60.5 years old. Fifty-five patients were female. 51 patients underwent robotic pancreatoduodenectomies, 34 distal pancreatectomy. Morbidity was 23.8%, mainly related to postoperative pancreatic fistula and one death occurred (mortality of 0.9%). Three patients (2.8%) were converted to open surgery. Four patients had delayed gastric emptying and two presented bleeding. Twenty-four patients had pancreatic fistula that was treated conservatively with late removal of the pancreatic drain. No patient required percutaneous drainage, reintervention or hospital readmission. Conclusions: the robotic platform is useful for the reconstruction of the alimentary tract after pancreatoduodenectomy or after central pancreatectomy. It may increase the preservation of the spleen during distal pancreatectomies. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency. Robotic resection of the pancreas is safe and feasible for selected patients. It should be performed in specialized centers by surgeons with experience in both open and minimally invasive pancreatic surgery.


RESUMO Objetivo: a primeira ressecção pancreática robótica no Brasil foi realizada por nossa equipe em 2008. Desde março de 2018, uma nova política nos levou a empregar sistematicamente o robô em todas cirurgias pancreáticas minimamente invasivas. O objetivo deste artigo é revisar nossa experiência com a ressecção pancreática robótica. Métodos: todos os pacientes submetidos a ressecção pancreática robótica de 2018 a 2019 foram incluídos. Variáveis pré- e intraoperatórias como idade, sexo, indicação, tempo cirúrgico, sangramento, diagnóstico, tamanho do tumor foram analisados. Resultados: 105 pacientes foram submetidos a pancreatectomia robótica. A idade mediana dos pacientes foi de 60,5 anos. 55 pacientes eram do sexo feminino. 51 pacientes foram submetidos a pancreatoduodenectomia, 34 pancreatectomia distal. A morbidade foi de 23,8% e ocorreu um óbito (mortalidade de 0,9%). Três pacientes (2,8%) tiveram a operação convertida para aberta. Quatro pacientes apresentaram retardo no esvaziamento gástrico e dois apresentaram sangramento. Vinte e quatro pacientes apresentaram fístula pancreática tratada de forma conservadora com remoção tardia do dreno pancreático. Nenhum paciente necessitou de drenagem percutânea, reintervenção ou readmissão hospitalar. Conclusões: a plataforma robótica é útil para a reconstrução do trato alimentar após pancreatoduodenectomia ou após pancreatectomia central. Pode aumentar a preservação do baço durante pancreatectomias distais. Técnicas poupadoras de pâncreas, como enucleação, ressecção de processo uncinado e pancreatectomia central, devem ser usadas para evitar insuficiência exócrina e/ou endócrina. A ressecção robótica do pâncreas é segura e viável para pacientes selecionados. Deve ser realizada em centros especializados por cirurgiões com experiência em cirurgia pancreática aberta e minimamente invasiva.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Pancreatectomy/methods , Pancreaticoduodenectomy/methods , Minimally Invasive Surgical Procedures/methods , Robotic Surgical Procedures/methods , Pancreatic Neoplasms/surgery , Brazil , Retrospective Studies , Laparoscopy/methods , Middle Aged
5.
Rev. cir. (Impr.) ; 71(6): 523-529, dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1058313

ABSTRACT

Resumen Introducción: La duodeno pancreatectomía cefálica es una operación compleja cuyos resultados a corto plazo son multifactoriales. Objetivo: Evaluar el impacto de la curva de aprendizaje en los resultados a corto plazo de la duodenopancreatectomía cefálica en un hospital de nivel II. Materiales y Método: Se analizaron los datos obtenidos a partir de una base de datos mantenida prospectivamente desde 2005. Se definieron dos periodos de tiempo: de 2005 a 2011 y de 2012 a 2017. Se compararon la morbilidad, mortalidad y estancia postoperatoria de ambos períodos. Resultados: Durante el período de tiempo estudiado se hicieron 126 duodenopancreatectomías cefálicas, 61 durante la primera etapa y 65 durante la segunda. La tasa de transfusión intraoperatoria se redujo de 33% a 15% (p = 0,011). La tasa de transfusión postoperatoria se redujo de 39 a 23% (p = 0,021). No hubo diferencias significativas con respecto a la incidencia global de complicaciones postoperatorias (59% y 52,3%). La incidencia de abscesos intraabdominales fue significativamente menor en el segundo período (18% y 4,6%, respectivamente; p = 0,038). La tasa de reintervenciones se redujo significativamente, de 22% a 9% (p = 0,049). También se redujo significativamente la tasa de mortalidad, de 6,56% a 0% (p = 0,032). La estancia media postoperatoria disminuyó significativamente en el segundo período, pasando de 19,6 a 15,8 días (p = 0,001), con una mayor proporción de pacientes dados de alta en los 8 primeros días de postoperatorio (11,5% y 38,5%, respectivamente; p = 0,001). Conclusión: La curva de aprendizaje es un factor que permite mejorar los resultados de la duodenopancreatectomía cefálica, en un hospital de nivel II, hasta alcanzar valores similares a los de un hospital de nivel III.


Introduction: The duodenum pancreatectomy cephalic is a complex operation whose short-term results are multifactorial. Aim: To assess the impact of the learning curve on the short-term outcomes of cephalic duodenopancreatectomy at a level II hospital. Materials Method: We analyze the data obtained from a database maintained prospectively since 2005. Two time periods were defined: from 2005 to 2011 and from 2012 to 2017. The morbidity, mortality and postoperative stay of both periods were compared. Results: 126 cephalic duodenopancreatectomies were performed, 61 during the first period and 65 during the second. The intraoperative transfusion rate was reduced from 33% to 15% (p = 0.011). The postoperative transfusion rate was reduced from 39 to 23% (p = 0.021). There were no significant differences with respect to the overall incidence of postoperative complications (59% and 52.3%, respectively). However, the incidence of intra-abdominal abscesses was significantly lower in the second period (18% and 4.6%, respectively, p = 0.038). The rate of reoperations was significantly reduced, from 22% to 9% (p = 0.049). The mortality rate was also significantly reduced, from 6.56% to 0% (p = 0.032). The mean postoperative stay decreased significantly in the second period, from 19.6 to 15.8 days (p = 0.001), with a higher proportion of patients discharged in the first 8 postoperative days (11.5% and 38.5%, respectively, p = 0.001). Conclusion: The learning curve is a factor allows improving the results of cephalic pancreaticoduodenectomy, in a level II hospital, until reaching values similar to those of a level III hospital.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Pancreaticoduodenectomy/adverse effects , Learning Curve , Postoperative Period , Pancreaticoduodenectomy/education , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/mortality
6.
Arq. gastroenterol ; 56(3): 246-251, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038717

ABSTRACT

ABSTRACT BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.


RESUMO CONTEXTO: A duodenopancreatectomia (DP) com ressecção de estruturas venosas adjacentes à cabeça do pâncreas, mesmo em casos de invasão extensa, tem sido praticada nos últimos anos, mas sua morbidade e mortalidade perioperatórias não são completamente determinadas. OBJETIVO: Descrever os resultados perioperatórios de DP com ressecções venosas realizadas em um hospital terciário universitário. MÉTODOS: Foi realizado estudo retrospectivo, classificado como coorte histórica, envolvendo 39 indivíduos submetidos à DP com ressecção venosa entre 2000 e 2016. Foram estudadas variáveis demográficas, clínicas e antropométricas pré-operatórias e os desfechos principais foram a morbidade e mortalidade em 30 dias. RESULTADOS: A mediana de idade foi 62,5 anos (IQ 54-68), sendo 55% dos indivíduos do sexo masculino. A principal etiologia identificada foi o adenocarcinoma ductal de pâncreas (82,1%). Em 51,3% dos casos, a veia porta foi submetida à ressecção; em 35,9%, a veia mesentérica superior foi ressecada e nos outros 12,8%, a junção esplenomesentérica. Em relação às complicações, 48,7% dos pacientes apresentaram algum tipo de morbidade em 30 dias. Nenhuma das variáveis analisadas associou-se à maior morbidade. A mortalidade perioperatória foi 15,4% (seis pacientes). O grupo de indivíduos que cursou com mortalidade em 30 dias apresentou escores significativamente mais altos de ASA (P=0,003) e ECOG (P=0,001). CONCLUSÃO: A DP com ressecção venosa para neoplasias avançadas do pâncreas é um procedimento factível, porém que se acompanha de altos índices de morbidade e mortalidade; escores de ASA e ECOG altos são fatores significativamente associados à maior mortalidade.


Subject(s)
Humans , Male , Female , Adult , Aged , Pancreatic Neoplasms/surgery , Adenocarcinoma/surgery , Pancreaticoduodenectomy/methods , Pancreatic Neoplasms/mortality , Portal Vein/surgery , Postoperative Complications , Brazil/epidemiology , Adenocarcinoma/mortality , Retrospective Studies , Morbidity , Pancreaticoduodenectomy/mortality , Intraoperative Complications , Mesenteric Veins/surgery , Middle Aged
7.
ABCD arq. bras. cir. dig ; 32(2): e1442, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019243

ABSTRACT

ABSTRACT Background: Solid pseudopapillary tumor of the pancreas is a rare low-grade malignant neoplasm. Most patients present with nonspecific symptoms until the tumor becomes large. Complete surgical resection by pancreatoduodenectomy is the treatment of choice for tumors located in the head of the pancreas Aim: To analyzed the clinicopathologic features, management, and outcomes of patients who had solid pseudopapillary tumor of the head pancreas and underwent surgical resection. Methods: Were analyzed 16 patients who underwent pancreatoduodenectomy for this condition. Results: Mean age was 25.7 years old, and 15 patients were female (93.7%). Nonspecific abdominal pain was present in 14 (87.5%). All underwent computed tomography and/or magnetic resonance imaging as part of diagnostic workup. The median diameter of the tumor was 6.28 cm, and surgical resection was performed with open or laparoscopic pancreatoduodenectomy without neoadjuvant chemotherapy. Postoperative complications occurred in six patients (37.5%) and included pancreatic fistula without mortality. The mean of hospital stay was 10.3 days. Median follow-up was 3.6 years, and no patient had local recurrence or metastatic disease. Conclusion: For these patients surgical resection with pancreatoduodenectomy is the treatment of choice showing low morbidity, no mortality, and good long-term survival.


RESUMO Racional: Tumor sólido pseudopapilar do pâncreas é neoplasia maligna rara, de baixo grau de malignidade. A maioria dos pacientes apresenta sintomas inespecíficos até que o tumor aumente de tamanho. A ressecção cirúrgica completa através a duodenopancreatectomia é o tratamento de escolha para os localizados na cabeça do pâncreas. Objetivo: Analisar as características clinicopatológicas, tratamento e resultados de pacientes com tumor sólido pseudopapilar do pâncreas localizado na cabeça do pâncreas submetidos à ressecção cirúrgica. Método: Foram analisados 16 pacientes com duodenopancreatectomia devido a esse tumor localizado na cabeça do pâncreas. Resultados: Havia 15 mulheres (93,7%) e a média de idade era de 25,7 anos. Dor abdominal não específica esteve presente em 14 pacientes (87,5%). Todos realizaram tomografia computadorizada do abdome e/ou ressonância nuclear magnética como parte da investigação. O diâmetro médio do tumor era de 6,28 cm e a ressecção cirúrgica foi realizada por duodenopancreatectomia, tanto por laparotomia quanto por videolaparoscopia, com ou sem quimioterapia neoadjuvante. As complicações pós-operatórias ocorreram em seis pacientes (37,5%) e incluíram fístula pancreática, sem mortalidade. O tempo médio de internação hospitalar foi de 10,3 dias. O tempo médio de seguimento foi de 3,6 anos e nenhum paciente apresentou recorrência local ou doença metastática. Conclusões: A ressecção cirúrgica através da duodenopancreatectomia é o tratamento de escolha para estes pacientes. Os resultados mostraram baixa morbidade, nenhuma mortalidade e boa sobrevida em longo prazo.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed
8.
ABCD arq. bras. cir. dig ; 32(1): e1412, 2019. tab, graf
Article in English | LILACS | ID: biblio-973383

ABSTRACT

ABSTRACT Background: Pancreaticoduodenectomy (PD) is a procedure associated with significant morbidity and mortality. Initially described as gastropancreaticoduodenectomy (GPD), the possibility of preservation of the gastric antrum and pylorus was described in the 1970s. Aim: To evaluate the mortality and operative variables of PD with or without pyloric preservation and to correlate them with the adopted technique and surgical indication. Method: Retrospective cohort on data analysis of medical records of individuals who underwent PD from 2012 through 2017. Demographic, anthropometric and operative variables were analyzed and correlated with the adopted technique (GPD vs. PD) and the surgical indication. Results: Of the 87 individuals evaluated, 38 (43.7%) underwent GPD and 49 (53.3%) were submitted to PD. The frequency of GPD (62.5%) was significantly higher among patients with pancreatic neoplasia (p=0.04). The hospital stay was significantly shorter among the individuals submitted to resection due to neoplasias of less aggressive behavior (p=0.04). Surgical mortality was 10.3%, with no difference between GPD and PD. Mortality was significantly higher among individuals undergoing resection for chronic pancreatitis (p=0.001). Conclusion: There were no differences in mortality, surgical time, bleeding or hospitalization time between GPD and PD. Pancreas head neoplasm was associated with a higher indication of GPD. Resection of less aggressive neoplasms was associated with lower morbidity and mortality.


RESUMO Racional : A duodenopancreatectomia (DP) é procedimento associado com significativa morbimortalidade. Inicialmente descrita como gastroduodenopancreatectomia (GDP), a possibilidade de preservação do antro gástrico e piloro foi descrita na década de 1970. Objetivo : Avaliar a mortalidade e variáveis operatórias da DP com ou sem preservação pilórica e correlacioná-las com a técnica adotada e indicação cirúrgica. Método: Estudo de coorte histórica, baseado em análise de dados de registros médicos de indivíduos submetidos à DP entre os anos de 2012 a 2017. Foram analisadas variáveis demográficas, antropométricas e operatórias e correlacionadas com a técnica adotada (GDP vs. DP) e a indicação cirúrgica. Resultados : Dos 87 indivíduos avaliados, 38 (43,7%) foram submetidos à GDP e 49 (53,3%) à DP. A frequência de realização da GDP (62,5%) foi significativamente maior entre os pacientes com neoplasia de pâncreas (p=0,04). O tempo de internação total foi significativamente menor entre os indivíduos submetidos à ressecção por neoplasias de comportamento menos agressivo (p=0,04). A mortalidade cirúrgica foi de 10,3%, não havendo diferença entre GDP e DP. A mortalidade foi significativamente maior entre os indivíduos submetidos à ressecção por pancreatite crônica (p=0,001). Conclusão : Não houve diferenças na morbimortalidade, tempo cirúrgico, sangramento ou tempo de internação entre GDP e DP. A neoplasia de cabeça de pâncreas associou-se mais com indicação de GDP. A ressecção de neoplasias menos agressivas associou-se a menor morbimortalidade.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Gastrostomy/methods , Gastrostomy/mortality , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/mortality , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/mortality , Bile Duct Neoplasms/surgery , Bile Duct Neoplasms/mortality , Pregnancy , Adenocarcinoma/surgery , Adenocarcinoma/mortality , Body Mass Index , Treatment Outcome , Cholangiocarcinoma/surgery , Cholangiocarcinoma/mortality , Statistics, Nonparametric , Duodenal Neoplasms/surgery , Duodenal Neoplasms/mortality , Operative Time , Length of Stay , Medical Illustration
9.
Acta cir. bras ; 33(1): 40-48, Jan. 2018. graf
Article in English | LILACS | ID: biblio-886246

ABSTRACT

Abstract Purpose: To compare the safety, feasibility, and short-term clinical benefits of laparoscopic pylorus-preserving pancreaticoduodenectomy (L-PPPD) to open pylorus-preserving pancreaticoduodenectomy (O-PPPD) through retrospective matched cases. Methods: Web of Science, Cochrane, PubMed, CNKI were searched systematically identify studies published between January and December 2017 comparing L-PPPD to O-PPPD. The meta-analysis was performed by using Review Manager 5.3. Results: Two studies matched the selection criteria, including 108 (50%) cases of laparoscopic pylorus-preserving pancreaticoduodenectomy and 108(50%) cases of open pylorus-preserving pancreaticoduodenectomy. None of the included studies were randomized, which were both retrospective matched cases. There was no difference in the incidence of postoperative pancreatic fistula, blood loss, diet start and lymph nodes. However, L-PPPD has a shorter hospital stay (p=0.0003) and O-PPPD has a shorter operative time (p=0.02) and tend to decrease the delayed gastric emptying. Conclusions: The perioperative safety of laparoscopic surgery, which also has advantages of minimal invasion and shorter hospital stay, is comparable to that of open surgery. Laparoscopic surgery could be operated if the patients matched the indication and operation difficulty is not so great. However, blind pursuits of L-PPPD should be restrained because there is no essential difference between these two in terms of feasibility, safety and short-term complication.


Subject(s)
Humans , Pylorus/surgery , Pancreaticoduodenectomy/methods , Laparoscopy/methods , Postoperative Complications , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Operative Time , Length of Stay
10.
Rev. chil. cir ; 70(2): 133-139, 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-959361

ABSTRACT

Resumen Introducción: La pancreatoduodenectomía es una cirugía compleja, con cifras de morbilidad cercanas a 30% y mortalidad entre 1 a 5%. El principal factor responsable de morbilidad y mortalidad es la fístula pancreática posoperatoria (FPPO). En la actualidad no existe una técnica universalmente estandarizada para la reconstrucción pancreática. Objetivo: Determinar la prevalencia de FPPO clínicamente relevante en una serie de pacientes en los que se realizó reconstrucción pancreática con pancreatoyeyunoanasto- mosis con técnica de Blumgart modificada para reconstrucción post-pancreatoduodenectomía en Hospital Hernán Henríquez Aravena entre los años 2014-2017. Material y Método: Serie de casos con seguimiento de julio de 2014 a abril de 2017. Se incluyeron pacientes a quienes se realizó reconstrucción pancreática con técnica de Blumgart modificada. La modificación consistió en el uso de pledgets® (poli-tetrafluoro- etileno) en los puntos iniciales en el páncreas con la idea de disminuir la posibilidad de desgarro del tejido. Se excluyeron pacientes a quienes se realizó otra técnica de reconstrucción. Se consideró FPPO clínicamente relevante (grado B/C) para evaluar morbilidad. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Resultados: Serie de casos de 12 pacientes, 9 (75%) de género femenino y 3 (25%) de género masculino. La edad promedio fue de 59 ± 8,5 años. La morbilidad fue de 25% y la tasa de fístula grado B/C fue 0%. Todas las fístulas pancreáticas fueron grado A (33,3%), sin relevancia clínica. Conclusión: La técnica de Blumgart modificada parece ser una técnica segura y reproducible para pancreato-yeyuyoanastomosis.


Introduction: Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancrea- tic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction. Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart's modified technique for post-pancreato- duodenectomy reconstruction at Hospital Hernán Henríquez Aravena between 2014 and 2017. Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart's modified technique were included. The modification consisted of the use of Pledgets® (poly-tetrafluoro-ethylene) at the inicial points in páncreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion. Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant. Conclusion: The Blumgart's modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pancreaticojejunostomy/adverse effects , Pancreatic Fistula/epidemiology , Pancreaticoduodenectomy/adverse effects , Postoperative Complications/epidemiology , Pancreaticojejunostomy/methods , Prevalence , Suture Techniques , Pancreatic Fistula/etiology , Pancreaticoduodenectomy/methods , Risk Assessment , Reconstructive Surgical Procedures
11.
ABCD arq. bras. cir. dig ; 30(3): 190-196, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-885731

ABSTRACT

ABSTRACT Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim: To understand the Brazilian practice patterns for pancreatoduodenectomy. Method: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy. The survey was sent to members who declared an interest in pancreatic surgery. Results: A total of 60 questionnaires were sent, and 52 have returned (86.7%). The Southeast had the most survey respondents, with 25 surgeons (48.0%). Only two surgeons (3.9%) performed more than 50% of their pancreatoduodenectomies by laparoscopy. A classic Whipple procedure was performed by 24 surgeons (46.2%) and a standard International Study Group on Pancreatic Surgery lymphadenectomy by 43 surgeons (82.7%). For reconstruction, pancreaticojejunostomy was performed by 49 surgeons (94.2%), single limb technique by 41(78.9%), duct-to-mucosa anastomosis by 38 (73.1%), internal trans-anastomotic stenting by 26 (50.0%), antecolic route of gastric reconstruction by 39 (75.0%), and Braun enteroenterostomy was performed by only six surgeons (11.5%). Prophylactic abdominal drainage was performed by all surgeons, and somatostatin analogues were utilized by six surgeons (11.5%). Early postoperative enteral nutrition was routine for 22 surgeons (42.3%), and 34 surgeons (65.4%) reported routine use of a nasogastric suction tube. Conclusion: Heterogeneity was observed in the pancreatoduodenectomy practice patterns of surgeons in Brazil, some of them in contrast with established evidence in the literature.


RESUMO Racional: A duodenopancreatectomia é um procedimento cirúrgico tecnicamente desafiador, com uma incidência de complicações pós-operatórias variando de 30% a 61%. O procedimento requer experiência de alto nível, e para minimizar complicações relacionadas à cirurgia uma padronização de alta qualidade é imperativa. Objetivo: Compreender o padrão da prática brasileira para duodenopancreatectomia. Método: Um questionário foi elaborado com a finalidade de obter uma visão geral da prática cirúrgica em câncer do pâncreas, treinamento específico e experiência em duodenopancreatectomia. O questionário foi enviado para cirurgiões com declarado interesse em cirurgia pancreática. Resultados: Um total de 60 questionários foi enviado e 52 retornaram (86,7%). A região sudeste foi a que mais respondeu, com 25 cirurgiões (48,0%). Apenas dois cirurgiões (3,9%), realizaram mais do que 50% das duodenopancreatectomia por videolaparoscopia. O procedimento clássico de Whipple foi realizado por 24 cirurgiões (46,2%) e a linfadenectomia padrão do Grupo Internacional de Estudo em Cirurgia Pancreática foi realizada por 43 cirurgiões (82,7%). Para a reconstrução, a pancreatojejunostomia foi realizada por 49 cirurgiões (94,2%), em alça única por 41 (78,9%), com anastomose do tipo ducto-mucosa por 38 (73,1%). O cateter transanastomose foi realizado por 26 cirurgiões (50%), reconstrução gástrica antecólica por 39 (75%) e enteroanastomose tipo Braun apenas por seis cirurgiões (11,5%). A drenagem abdominal profilática foi realizada por todos os cirurgiões e o uso de análogos da somatostatina por seis cirurgiões (11,5%). Nutrição enteral precoce no pós-operatório foi utilizada de rotina por 22 cirurgiões (42,3%) e 34 cirurgiões (65,4%), usaram sonda nasogástrica de rotina. Conclusão: Heterogeneidade foi observada na prática padrão da duodenopancreatectomia pelos cirurgiões no Brasil e, algumas delas em contraste com evidências estabelecidas na literatura.


Subject(s)
Humans , Pancreatic Neoplasms/surgery , Practice Patterns, Physicians' , Pancreaticoduodenectomy/standards , Brazil , Pancreaticoduodenectomy/methods , Health Care Surveys
12.
Rev. argent. cir ; 108(4): 1-10, dic. 2016. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-957884

ABSTRACT

Antecedentes: la duodenopancreatectomía cefálica (DPC) es la cirugía indicada para el tratamiento de los tumores ampulares y periampulares. El abordaje totalmente laparoscópico es técnicamente dificil de realizar pues requiere mucha destreza y experiencia por parte del equipo quirúrgico. La dificultad técnica de la pancreato-yeyuno anastomosis es quizás el factor limitante para confeccionar la duode-nopancreatectomía cefálica enteramente por vía laparoscópica. Objetivo: mostrar la técnica de reconstrucción laparoscópica con la pancreato-yeyuno anastomosis ductomucosa con la técnica de Blumgart modificada. Lugares de aplicación: Sanatorio de la Trinidad Mitre, Hospital Luciano y Mariano de la Vega, Hospital Argerich. Material y Métodos: se analizaron los pacientes operados enteramente por vía laparoscópica. Dichos pacientes fueron reconstruidos con una sola asa, realizando una pancreato-yeyuno anastomosis con la técnica de Blumgart modificada. Resultados: en los pacientes con DPC totalmente laparoscópica, el páncreas fue de textura intermedia en 3 pacientes y en 2 con textura blanda. El tempo operatorio medio fue 384 minutos. La estadía hospitalaria media fue 12 días. Dos pacientes desarrollaron fistula pancreática tipo A. Un paciente presentó retardo del vaciamiento gástrico que resolvió espontáneamente. Conclusiones: la reconstrucción completa por vía laparoscópica es factble y totalmente reproducible con la misma técnica que se utliza por vía laparotómica.


Background: pancreatoduodenectomy is the procedure indicated for the treatment of ampullary and periampullary tumors. The total laparoscopic approach for pancreatoduodenectomy is technically dificult to perform requiring skill and great experience of the surgical team. The technical dificulty of the pancreatojejunostomy is perhaps the limiting factor to perform the pancreatoduodenectomy totally laparoscopic. Objective: to describe the technique of the laparoscopic reconstructon using the pancreatojejunos-tomy according to the Blumgart modifed technique. Material and methods: patentis operated entrely by totally laparoscopic approach were analyzed. These patentis were reconstructed performing a pancreatojejunostomy with the Blumgart modifed technique. Resultis: in patentis with totally laparoscopic approach, pancreas texture was intermediatein 3 pa-tentis and 2 had sof texture. The average operating tme was 384 minutes. The average hospital stay was 12 days. Two patentis developed pancreatic fistula type A. One patent had delayed gastric emp-tying which resolved spontaneously. Conclusion: total laparoscopic reconstructon is feasible and reproducible with the same technique used by laparotomy.


Subject(s)
Humans , Pancreaticojejunostomy/methods , Pancreaticoduodenectomy/methods , Pancreas , Surgical Procedures, Operative/methods , Laparoscopy , Neurilemmoma/surgery , Neurilemmoma/diagnosis
14.
Clinics ; 71(1): 28-35, Jan. 2016. tab, graf
Article in English | LILACS | ID: lil-771946

ABSTRACT

The aim of this study is to address the outcomes of endoscopic resection compared with surgery in the treatment of ampullary adenomas. A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For this purpose, the Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and data considering endoscopic treatment compared with surgery. The entire analysis was based on a fixed-effects model. Five retrospective cohort studies were selected (466 patients). All five studies (466 patients) had complete primary resection data available and showed a difference that favored surgical treatment (risk difference [RD] = -0.24, 95% confidence interval [CI] = -0.44 to -0.04). Primary success data were identified in all five studies as well. Analysis showed that the surgical approach outperformed endoscopic treatment for this outcome (RD = -0.37, 95% CI = -0.50 to -0.24). Recurrence data were found in all studies (466 patients), with a benefit indicated for surgical treatment (RD = 0.10, 95% CI = -0.01 to 0.19). Three studies (252 patients) presented complication data, but analysis showed no difference between the approaches for this parameter (RD = -0.15, 95% CI = -0.53 to 0.23). Considering complete primary resection, primary success and recurrence outcomes, the surgical approach achieves significantly better results. Regarding complication data, this systematic review concludes that rates are not significantly different.


Subject(s)
Humans , Adenoma/surgery , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Duodenal Neoplasms/surgery , Endoscopy/methods , Endoscopy/adverse effects , Pancreaticoduodenectomy/methods , Recurrence , Treatment Outcome
15.
Rev. méd. Chile ; 143(5): 673-676, ilus, tab
Article in Spanish | LILACS | ID: lil-751713

ABSTRACT

Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution.


Subject(s)
Female , Humans , Middle Aged , Hepatic Artery/abnormalities , Pancreaticoduodenectomy/methods , Anatomic Variation , Hepatic Artery/surgery , Medical Illustration
16.
Arq. gastroenterol ; 51(1): 29-33, Jan-Mar/2014. tab
Article in English | LILACS | ID: lil-706995

ABSTRACT

Context Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the “Achilles’ heel” of the procedure. Objective To evaluate the post-operative 30 days morbidity and mortality rates. Methods Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate). Results Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusions The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients. .


Contexto A duodenopancreatectomia é o procedimento de escolha para neoplasias ressecáveis da região periampolar. Estes tumores representam 4% dos óbitos por câncer, sendo referida como uma das mais baixas taxas de sobrevida em 5 anos. A cirurgia continua sendo um procedimento complexo com substancial morbi-mortalidade. Apesar dos relatos de até 30% de mortalidade, em serviços de excelência tem sido apontada como inferior a 5% e estudos recentes mostram que a pancreatojejunostomia representa o “tendão de Aquiles” do procedimento. Objetivo Avaliar a morbi-mortalidade em 30 dias nesta série de pacientes ressecados. Métodos Analisamos até o momento dados de 97 pacientes consecutivos submetidos à duodenopancreatectomia de julho de 2000 a dezembro de 2012. Todos os pacientes foram manejados pelo mesmo grupo e os dados obtidos de banco de dados específico do serviço. O objetivo principal era avaliar a mortalidade em 30 dias, mas também foi reportado os dados referentes ao espécime cirúrgico, a necessidade de ressecção vascular e complicações pós-operatórias (estase gástrica, fístula pancreática, pneumonia e taxa de reoperação). Resultados A mortalidade em 30 dias foi 2.1% (dois pacientes). Em 93.8% dos pacientes a ressecção foi completa com margem microscópica tumoral negativa e em 67.3% dos casos não se detectou linfonodos metastáticos ao estudo anatomopatológico. Entre as complicações pós-operatórias, foram relatadas 6% de estase gástrica prolongada, 10.3% de pneumonia, 10.3% de fístula pancreática e 1% de infecção no trajeto do dreno. Dois pacientes foram submetidos a reoperação devido a sangramento e hematoma infectado decorrente de fístula pancreática. Um paciente foi reoperado por ...


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/mortality , Disease-Free Survival , Pancreatic Neoplasms/mortality , Pancreaticoduodenectomy/adverse effects , Pancreaticoduodenectomy/methods , Retrospective Studies , Treatment Outcome
17.
Arq. gastroenterol ; 50(3): 214-218, July-Sept/2013. tab, graf
Article in English | LILACS | ID: lil-687247

ABSTRACT

Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6%) were performed totally laparoscopic; 4 (4.2%) needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%). Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons. .


Contexto Nossa experiência com ressecção pancreática laparoscópica começou em 2001. No início, a laparoscopia esteve reservada para casos selecionados. Com o aumento da experiência, procedimentos mais complexos, como pancreatectomia central e pancreato duodenectomia, foram realizadas por laparoscopia. Objetivos O objetivo deste trabalho foi rever a experiência de 11 anos com ressecção pancreática laparoscópica. Métodos Foram analisados todos os pacientes submetidos à ressecção pancreática laparoscópica entre 2001 e 2012 e incluídos dados pré-operatórios como idade, sexo e indicação cirúrgica, bem como variáveis intra-operatórias como o tempo operatório, o sangramento e transfusão. O diagnóstico final, o tamanho e a margem foram determinados a partir dos laudos anatomopatológicos. Resultados Desde 2001, 96 pacientes foram submetidos à pancreatectomia laparoscópica. A média de idade foi de 55 anos. Foram 60 homens e 36 mulheres. Oitenta e oito (91,6%) operações foram realizadas por laparoscopia e quatro (4,2%) necessitaram de auxílio da mão e uma robótica. Três pacientes foram convertidos. Quatro necessitaram de transfusão de sangue. O tempo operatório variou de acordo com tipo de operação. A mortalidade foi nula, mas a morbidade foi alta, principalmente devido à fístulas pancreáticas (28,1%). Sessenta e um pacientes foram submetidos à pancreatectomia distal, 18 à enucleação do pâncreas, 7 à duodenopancreatectomia com preservação de piloro, 5 à ressecção do processo uncinado, 3 centrais e duas pancreatectomias totais. Conclusão Ressecção laparoscópica ...


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Laparoscopy/methods , Pancreatectomy/methods , Pancreatic Fistula/surgery , Pancreaticoduodenectomy/methods , Cholangiopancreatography, Magnetic Resonance , Medical Illustration , Pancreatectomy/trends , Retrospective Studies , Tomography, X-Ray Computed
18.
Rev. chil. cir ; 64(3): 257-263, jun. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-627107

ABSTRACT

Background: Pancreatic reconstruction in pancreatoduodenectomy (PD) has many technical options. Evidence shows no difference in pancreatic fistula rate or mortality between pancretogastrostomy and pancrea-ticojejunostomy reconstruction. Aim: To report the results of the technique used by our team to perform duct-to-mucosa pancreaticogastrostomy (DMPG) in PD. Material and Methods: Follow up of 37 patients aged 53 +/- 12 years (59 percent women), subjected to pancreatoduodenectomy, using DMPG. Perioperative complications were reported using the Dindo-Clavien classification. Results: All patients had a pancreatic cancer. The tumor was located in the head or ampulla of Vater in 38 percent of patients. The most common histological type was adenocarcinoma in 33 patients (89 percent). Seventy three percent of patients did not have regional lymph node involvement (NO). Two patients died (5 percent). Postoperative complications were registered in 35 percent of patients. Two patients developed pancreatic fistulas, that were type A and B I one patient each, according to the classification of the International Study Group on Pancreatic Fistula. Conclusions: The morbidity and mortality associated with DMPG in PD in the reported cohort are comparable to those reported by other local studies.


Introducción: Para la reconstrucción pancreática en pancreatoduodenectomía (PD) existen diversas técnicas; la evidencia científica no demuestra diferencia en el porcentaje de fístulas pancreáticas ni morbi-mortalidad entre la reconstrucción con pancreatogastrostomía y pancreatoyeyunostomía. Nuestro objetivo es describir la técnica de pancreato-gastro anastomosis ducto-mucosa (PGADM) y los resultados en términos de morbimortalidad de esta técnica utilizada para la reconstrucción pancreática en PD. Material y Método: Estudio de serie de casos con seguimiento. Se incluyeron pacientes mayores de 15 años que fueron sometidos a PD y en los cuales se realizó reconstrucción pancreática con PGADM por el equipo de cirugía hepatopancreática y biliar del Hospital Regional de Temuco desde 1996 hasta 2010. Se reportó morbilidad perioperatoria según la clasificación de Dindo-Clavien. Se aplica estadística descriptiva. Resultados: La cohorte está constituida por 37 pacientes, la edad promedio fue 53 +/- 12 años y el 59 por ciento género masculino. Todos los pacientes tienen confirmación histopatológica de neoplasia, siendo los orígenes más frecuentes la cabeza del páncreas y ampolla de Vater con un 38 por ciento. El tipo histológico más frecuente fue el adenocarcinoma en 33 pacientes (89 por ciento). El 73 por ciento de los pacientes no tenía compromiso de ganglios linfáticos regionales (N0). La morbilidad peri operatoria fue de 35 por ciento. Dos pacientes presentaron fístulas pancreáticas (5,4 por ciento), uno tipo A y otra tipo B según la clasificación de la ISGPF. La mortalidad perioperatoria es de 2 pacientes (5 por ciento). Conclusiones: La morbi-mortalidad asociada a PD con reconstrucción pancreática con PGADM es comparable a la reportada por series nacionales.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Postoperative Complications/epidemiology , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/adverse effects , Pancreaticoduodenectomy/methods , Follow-Up Studies , Gastrostomy , Morbidity , Neoplasm Staging , Pancreatic Neoplasms/mortality , Survival Analysis
19.
Acta cir. bras ; 27(2): 123-130, Feb. 2012. tab
Article in English | LILACS | ID: lil-614530

ABSTRACT

PURPOSE: To evaluate the nutritional status of patients in the late postoperative period of pancreaticoduodenectomy (PD) and compare the long-term outcome according to pylorus-preserving (PPPD) or the standard technique (SPD) in which the pylorus is resected. METHODS: This prospective study was conducted twelve months prior or more in patients who had underwent PD (PD Group, n=15) and health volunteers (Control Group, n=15). At a post hoc analysis, the PD Group was divided in PPPD Subgroup (n=9) and SPD Subgroup (n=6), according to the PD techniques. Gastrointestinal complaints and nutritional status were evaluated, apart from a biochemical assessment; Student t-test or Mann-Whitney test were used. RESULTS: The patients recovered their body weight and the gastrointestinal complaints were uncommon. The PD Group showed higher energy and protein intake even though BMI was lower than in Control Group. There were no differences in laboratorial data, except for higher glycemia, serum alkaline phosfatase and C-reactive protein in PD Group. There was no difference in the various parameters evaluated when the Subgroups (PPPD and SPD) were compared. CONCLUSION: For long-term pancreaticoduodenectomy, the gastrointestinal symptoms are minimal and the patients had the clinical and nutritional status preserved, regardless of pylorus preservation.


OBJETIVO: Avaliar o estado nutricional de pacientes em pós-operatório tardio de pancreaticoduodenectomia (PD) e comparar a evolução de acordo com a preservação de piloro (PPPD) ou pela técnica padrão com ressecção do piloro (SPD). MÉTODOS: O estudo prospectivo foi conduzido com pacientes submetidos à PD após período mínimo de 12 meses (Grupo PD, n=15) e voluntários saudáveis (Grupo Controle, n=15). Numa análise posterior, o Grupo PD foi dividido em Subgrupo PPPD (n=9) e Subgrupo SPD (n=6), de acordo com a técnica de PD. Foram avaliadas as queixas digestivas, o estado nutricional e dados bioquímicos; a análise estatística foi realizada por meio do teste t-Student ou Mann-Whitney. RESULTADOS: Os pacientes recuperaram o estado nutricional e as queixas gastrointestinais foram incomuns. A ingestão protéica e energética foi maior no Grupo PD, apesar do menor IMC. Não houve diferenças em relação aos exames laboratoriais, exceto pelos maiores níveis de glicemia, fosfatase alcalina sérica e proteína C-reativa no Grupo PD. Quando os Subgrupos PPPD e SPD foram comparados, não houve diferenças nos diversos parâmetros analisados. CONCLUSÃO: No pós-operatório tardio de pancreaticoduodenectomia, os sintomas gastrointestinais são mínimos e o estado clínico e nutricional é adequado, independente da preservação do piloro.


Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Nutritional Status/physiology , Pancreaticoduodenectomy/methods , Pylorus/surgery , Age Factors , Blood Proteins , Body Mass Index , Postoperative Period , Prospective Studies , Sex Factors , Statistics, Nonparametric , Time Factors , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL