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1.
Article in English | MEDLINE | ID: mdl-38522846

ABSTRACT

This study aimed to compare outcomes of hand-sewn and stapler closure techniques of pancreatic stump in patients undergoing distal pancreatectomy (DP). Impact of stapler closure reinforcement using mesh on outcomes was also evaluated. Literature search was carried out using multiple data sources to identify studies that compared hand-sewn and stapler closure techniques in management of pancreatic stump following DP. Odds ratio (OR) was determined for clinically relevant postoperative pancreatic fistula (POPF) via random-effects modelling. Subsequently, trial sequential analysis was performed. Thirty-two studies with a total of 4,022 patients undergoing DP with hand-sewn (n = 1,184) or stapler (n = 2,838) closure technique of pancreatic stump were analyzed. Hand-sewn closure significantly increased the risk of clinically relevant POPF compared to stapler closure (OR: 1.56, p = 0.02). When stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.54, p = 0.002). When only randomized controlled trials were considered, there was no significant difference in clinically relevant POPF between hand-sewn and stapler closure techniques (OR: 1.20, p = 0.64) or between reinforced and standard stapler closure techniques (OR: 0.50, p = 0.08). When observational studies were considered, hand-sewn closure was associated with a significantly higher rate of clinically relevant POPF compared to stapler closure (OR: 1.59, p = 0.03). Moreover, when stapler closure was considered, staple line reinforcement significantly reduced formation of such POPF (OR: 0.55, p = 0.02). Trial sequential analysis detected risk of type 2 error. In conclusion, reinforced stapler closure in DP may reduce risk of clinically relevant POPF compared to hand-sewn closure or stapler closure without reinforcement. Future randomized research is needed to provide stronger evidence.

2.
HPB (Oxford) ; 20(9): 848-853, 2018 09.
Article in English | MEDLINE | ID: mdl-29705345

ABSTRACT

BACKGROUND: Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma. The effect of blood group is not known, however, among patients with other periampullary cancers. This study sought to review this. METHODS: Data were collected for a range of factors and survival outcomes from patients treated at two centres. Those with blood groups B and AB were excluded, due to small numbers. Patient survival was compared between patients with blood groups O and A using multivariable analysis which accounted for confounding factors. RESULTS: Among 431 patients, 235 (54.5%) and 196 (45.5%) were of blood groups A and O respectively. Baseline comparisons found a significant difference in the distribution of tumour types (p = 0.011), with blood group O patients having more ampullary carcinomas (33.2% vs 23.4%) and less pancreatic ductal adenocarcinomas (45.4 vs 61.3%) than group A. On multivariable analysis, after accounting for confounding factors including pathologic variables, survival was found to be significantly shorter in those with blood group A than group O (p = 0.047, HR 1.30 [95%CI: 1.00-1.69]). CONCLUSIONS: There is a difference in the distribution of blood groups across the different types of periampullary cancers. Survival is shorter among blood group A patients.


Subject(s)
ABO Blood-Group System , Ampulla of Vater/surgery , Bile Duct Neoplasms/surgery , Carcinoma, Pancreatic Ductal/surgery , Cholangiocarcinoma/surgery , Duodenal Neoplasms/surgery , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Aged , Ampulla of Vater/pathology , Bile Duct Neoplasms/blood , Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/pathology , Carcinoma, Pancreatic Ductal/blood , Carcinoma, Pancreatic Ductal/mortality , Carcinoma, Pancreatic Ductal/pathology , Cholangiocarcinoma/blood , Cholangiocarcinoma/mortality , Cholangiocarcinoma/pathology , Databases, Factual , Duodenal Neoplasms/blood , Duodenal Neoplasms/mortality , Duodenal Neoplasms/pathology , England , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/blood , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/adverse effects , Pancreaticoduodenectomy/mortality , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
3.
Clin Transplant ; 31(11)2017 Nov.
Article in English | MEDLINE | ID: mdl-28871663

ABSTRACT

BACKGROUND: The demand for kidney retransplantation following graft failure is rising. Repeat transplantation is often associated with poorer outcomes due to both immunological and surgical challenges. The aim of this study was to compare surgical and functional outcomes of kidney retransplantation in recipients that had previously had at least two kidney transplants with a focus on those with antibody incompatibility. METHODS: We analyzed 66 patients who underwent renal transplantation at a single center between 2003 and 2011. Consecutive patients receiving their 3rd or 4th kidney were case-matched with an equal number of 1st and 2nd transplants. RESULTS: Twenty-two 3rd and 4th kidney transplants were matched with 22 first and 22 seconds transplants. Operative times and length of stay were equivalent between the subgroups. Surgical complication rates were similar in all groups (22.7% in 1st and 2nd transplants, and 27.2% in 3rd/4th transplants). There was no significant difference in patient or graft survival over 5 years. Graft function was similar between transplant groups at 1, 3, and 5 years. CONCLUSIONS: Third and fourth kidney transplants can be performed safely with similar outcomes to 1st and 2nd transplants. Kidney retransplantation from antibody-incompatible donors may be appropriate for highly sensitized patients.


Subject(s)
Graft Rejection/prevention & control , Histocompatibility Testing , Kidney Transplantation , Living Donors , Postoperative Complications/prevention & control , Reoperation , Tissue and Organ Procurement/methods , Adult , Case-Control Studies , Female , Follow-Up Studies , Glomerular Filtration Rate , Graft Rejection/epidemiology , Graft Survival , Humans , Kidney Failure, Chronic/surgery , Kidney Function Tests , Male , Prognosis , Registries , Risk Factors , Survival Rate , United Kingdom/epidemiology
4.
Hepatobiliary Pancreat Dis Int ; 15(6): 655-659, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27919856

ABSTRACT

Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase (ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1 (POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.


Subject(s)
Alanine Transaminase/blood , Colorectal Neoplasms/pathology , Hepatectomy/adverse effects , Liver Neoplasms/surgery , Postoperative Complications/blood , Adult , Aged , Biomarkers/blood , Catheter Ablation/adverse effects , Colorectal Neoplasms/mortality , Databases, Factual , Elective Surgical Procedures , England , Female , Hepatectomy/mortality , Humans , Liver Neoplasms/mortality , Liver Neoplasms/secondary , Male , Middle Aged , Neoadjuvant Therapy/adverse effects , Postoperative Complications/etiology , Postoperative Complications/mortality , Predictive Value of Tests , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Up-Regulation
5.
Hepatobiliary Pancreat Dis Int ; 12(3): 310-6, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23742777

ABSTRACT

BACKGROUND: Intraperitoneal local anesthesia (IPLA) during elective laparoscopic cholecystectomy (el-LC) decreases post-operative pain. None of the studies have explored the efficacy of IPLA at emergency laparoscopic cholecystectomy (em-LC). A longer operative duration, the greater frequency of washing, and the inflammation associated with cholecystitis or pancreatitis are a few reasons why it cannot be assumed that a benefit in pain scores will be seen in em-LC with IPLA. This study was undertaken to assess the efficacy of IPLA in patients undergoing em-LC. METHODS: Double-blind randomized sham controlled trial was conducted of 41 consecutive subjects undergoing em-LC. IPLA was delivered by a combination of injection to the diaphragmatic and topical wash over the liver and gallbladder with bupivacaine or saline. The primary outcome was visual analogue scale pain scores until discharge. Secondary outcomes included pain scores in theatre recovery and analgesic consumption. RESULTS: One patient had a procedure converted to open and was excluded. There was no significant difference in pain scores in the ward or theatre recovery. Analgesic use, respiratory rate, oxygen saturation, duration to ambulation, eating, satisfaction scores, and time to discharge were comparable between the two groups. CONCLUSIONS: IPLA during em-LC does not influence postoperative pain. Other modalities of analgesia should be explored for decreasing the interval between diagnosis of acute admission and em-LC.


Subject(s)
Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Cholecystectomy, Laparoscopic , Pain, Postoperative/prevention & control , Administration, Topical , Adult , Analgesics/therapeutic use , Cholecystectomy, Laparoscopic/adverse effects , Double-Blind Method , Emergencies , England , Female , Humans , Injections, Intraperitoneal , Length of Stay , Male , Middle Aged , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Patient Discharge , Therapeutic Irrigation , Time Factors , Treatment Outcome
6.
Transplantation ; 86(3): 474-7, 2008 Aug 15.
Article in English | MEDLINE | ID: mdl-18698253

ABSTRACT

Current methods of measuring ABO antibody levels based on the hemagglutination (HA) titers have the disadvantages of relatively poor reproducibility and do not offer fine discrimination of antibody concentration. We therefore developed a simple and rapid method of measuring ABO antibody levels using flow cytometry (FC). For validation, we analyzed plasma samples from 79 blood donors. Both IgM and IgG were detected and measured with IgG essentially restricted blood group O donors. Forty-two successive samples were collected from a patient with blood group O undergoing antibody removal and subsequent transplantation from a group A2 donor and tested by both HA and FC. Changes in IgG measured by FC (relative median fluorescence) correlated well with HA titers and importantly rejection episodes were preempted by a rising relative median fluorescence. The method allowed quantitative discrimination in the range of antibody levels relevant to ABO incompatible transplantation and has the advantages over HA of objective measurement and reproducibility.


Subject(s)
ABO Blood-Group System , Blood Group Incompatibility , Flow Cytometry , Immunoglobulin G/blood , Immunoglobulin M/blood , Isoantibodies/blood , Kidney Transplantation , Blood Grouping and Crossmatching , Hemagglutination Tests , Humans , Predictive Value of Tests , Reproducibility of Results , Time Factors
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