Efficacy of percutaneous biliary and pancreatic duct drainage/stenting with double invaginated pancreatojejunostomy after pancreatoduodenectomy.

AIM: To evaluate the efficacy and feasibility of preoperative percutaneous pancreatic duct drainage (PPDD) and improve the safety of pancreatojejunal anastomosis, we refer to our experience from 2013 to 2017 that include the last series of 27 cases of PD for 14 pancreatic and 13 ampullary tumors. Apart from the standard "classic" Whipple procedure in 17 cases, and the "modified"pylorus-preserving variant (ppPD) in 10 cases, in 26 cases a pancreaticojejunostomy and in 1 case a pancreatico gastrostomy was performed. In last series the percutaneous biliary drainage procedure in 18 cases and dual biliary + pancreatic duct decompression in 4 casas was performed. In 21 cases the biliary drainage was used as transanastomotic stent during hepaticojejunostomy and in 3 cases the pancreatic duct drainage was also used as transanastomitic stent at our method of performing the double invaginated pancreatojejunostomy. RESULTS: Without operative mortality in our series of PD, there were however some complications requiring in two patients interventional radiologic and intensive care management, and 5 patients died at follow up period (6 months - 3 years). There was no postoperative pancreatic fistula in our last series of PD, where preoperative biliary and pancreatic duct drainage and our modified double invaginated pancreatojejunostomy was performed. CONCLUSIONS: Despite our limited experience, we can conclude that preoperative percutaneous biliary and pancreatic drainage is feasible, safe, effective and a realistic mini invasive procedure. The preliminary results obtained with the described method of double invaginated pancreatojejunostomy with transanastomotic stent and external pancreatic duct drainage are very encouraging and indicate that this technique is less complicated and time consuming, very safe, simple, easy to perform and also applicable almost to all situations. KEY WORDS: Invaginated Pancreatojejunostomy Pancreatoduodenectomy, Pancreatic Duct Drainage.

Miniinvasive surgical interventions in management of cholelithiasis A retrospective study.

The aim of the present study is to analyze outcomes after laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) for gallstone disease and determine the algorithm of treatment for different groups of patients according to the age, severity of disease and comorbid conditions. This is a multicenter retrospective review of 2997 patients who underwent LC or MC between January 1, 2002 and December 31, 2008. The patients were categorized into LC (1479) and MC (1518) groups. When preoperative examination data were not reliable, we performed abdominal wall lifting with the retractors to visualise abdominal cavity with laparoscope during minilaparotomy. There were statistically significant differences in conversion rate (47 LC and 22 MC cases) (P=0.002), mean operating time (76 and 55 minutes in LC and MC, respectively) (P<0.001), mean duration of usage of non-narcotic analgesics postoperatively (1.3 and 1.1 days in LC and MC, respectively) (P<0.001), intra (15 LC and 6 MC cases) (P=0.02) and postoperative complications (96 LC and 72 MC cases) (P=0.05) and in mean hospital stay (1.5 and 1.3 days in LC and MC, respectively) (P<0.001). The difference in outcomes was more significant in elderly and senile patients. Following the review of previous trials, the only clear significant difference between both procedures was a shorter operative time using MC 24. MC is an attractive alternative for elderly patients, with their high incidence of acute cholecystitis 23. The minilaparotomy cholecystectomy is effective, safe and optimal operative procedure. Especially, it is important for countries with lower economic capacity.

[Bacteria endocarditis of dental origin with neurological complications]. / Endocardite bactérienne d'origine dentaire avec complications neurologiques.

A 49 years old man suffered from transient hemiplegic episodes following bacterial endocarditis, cultures being negative and with a fever resistant to antibiotics. Complete stomatological evaluation revealed multiple dental infective sites constituting "portals of entry". Radical treatment of these sites contributed to the complete cure of the infective syndrome.