Pylorus preserving pancreaticoduodenectomy with low incidence of early delayed gastric emptying.

BACKGROUND AND OBJECTIVE: Early delayed gastric emptying (early DGE) is a common complication after pylorus-preserving pancreaticoduodenectomy (PPPD). The authors studied the occurrence of early DGE in the presented patients. The explanation of authors' results was discussed and a brief literature review was performed. MATERIAL AND METHOD: The occurrence of early DGE was studied in 37 patients with periampullary neoplasms or other benign conditions who underwent PPPD between from April 1992 and March 2006. The operations were performed by the first author with uniform surgical techniques. After the year 2000, an external pancreatic stent was routinely inserted into the pancreatic duct during pancreaticojejunostomy anastomosis. RESULTS: Early DGE occurred in two patients (5.4%), one in the non-stented and one in the stented group. Two patients had pancreatic fistula and two had wound infection. The overall morbidity rate was 16.2%. There was no re-operation or intra-abdominal abscess requiring drainage or mortality in the present study. CONCLUSIONS: The occurrence of early DGE after PPPD may be lessened by strict awareness and avoidance of complications associated with PPPD. Surgical experiences with faultless and meticulous surgical techniques are important for lowering such complications.

Successful management of a superior mesenteric artery aneurysm by ligation: a case report.

Superior mesenteric artery aneurysm (SMAA) is a rare entity. Management varies from simple ligation with or without revascularization to endovascular placement of a covered stent graft. The authors report a case of SMAA who presented with retroperitoneal hemorrhage. Diagnosis was made from abdominal computed tomography and angiography. The cause of SMAA was not definitely identified but infective origin was highly suspicious. The patient underwent successful treatment with ligation of the superior mesenteric artery proximal and distal to the SMAA.

Outcome of colorectal liver metastases.

OBJECTIVE: To determine the median survival of colorectal liver metastatic (CRLM) patients treated at King Chulalongkorn Memorial Hospital over the past 10 years and to determine the outcome of the various treatment modalities (surgery, chemotherapy and supportive treatment). MATERIAL AND METHOD: Between January, 1992 and December, 2001, 86 consecutive patients were recorded. Of whom 26 (30.23%) received liver resection, 39 (45.34%) received chemotherapy and 21 (24.41%) received supportive treatment. All the patients were followed up to December 31, 2001 or death. Survival was calculated by Kaplan-Meier method and studied for statistical differences between various treatment groups with Cox regression model. The 95% confidence intervals for median assessment were determined. RESULTS: Overall survival of CRLM patients was 18 months. Significant differences in survival were seen among the three groups of patients. Median survival was 33 months in the liver resection group, 17 months in the chemotherapy group and 5 months in the supportive treatment group. Three-year survival in the liver resection group was 23% while it was 7.6% in the chemotherapy group. Type of treatment, primary tumor staging and extrahepatic metastasis were the three independent determinant factors of survival. CONCLUSION: Survival of patients with colorectal liver metastases depends on the type of treatment. Liver resection is the best treatment which offers long term survival to the patients in selected cases.