BackgroundThis study was to explore a safe and effective procedure to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD).MethodsForty-three modified PD with pancreaticojejunostomy by direct invagination of the pancreas to the jejunum that was brought up via the space behind the root of superior mesenteric vessel were performed between January 2003 and June 2006, and were compared to the fifty-six conventional PD (Child’ method).ResultsThere was no pancreatic fistula after PD in the modified group. Two cases developed biliary fistula that were successfully treated with complete drainage for 2 to 3 weeks; 2 cases abdominal infection managed with anti-infection and completely drainage; 4 cases stress ulcer cured with Losec and coagulant. Three cases in the Child group developed PF of different severities, with amylase level > 9000 U/L in the abdominal drainage fluid. Two of the PF were treated with Stilamin, parenteral nutrition, fasting and completely drainage and cured after 21 to 32 days. The other 82-year-old patient died. Other complications had no significant difference between the two groups (P > 0.05).ConclusionsThe modified PD can effectively prevent PF and is a safe and effective procedure for periampullary neoplasm. Further studies of its clinical use are warranted.
BackgroundBudd-Chiari syndrome (BCS) is defined as chronic, progressive and congestive liver dysfunction resulting from obstruction of the outflow of inferior vena cava (IVC) and/or hepatic veins. One of the common types of BCS is short segmental occlusion of retrohepatic IVC (SSOR-IVC) accompanied by varied extent of obstruction of intrahepatic veins. The mainstay of surgical treatment at present for SSOR-IVC is cavoartrial bypass via thoracolaparotomic approach, in which thoracic and pulmonary complications intra- and/or post-operation are common. We have developed an abdominal approach using suprahepatic and retrohepatic inferior vena cavocaval bypass to treat SSOR-IVC, herein we compared it with the conventional thoracolaparotomic approach.MethodsFrom 2005 to 2008, we performed suprahepatic and retrohepatic inferior vena cavocaval bypass using artificial vessel in 16 BCS patients with SSOR-IVC (group A), we compared the results of this new modality with that using traditional thoracolaparotomic approach in 18 patients (group B) from 2001 to 2004.ResultsIn group A, one patient had intraoperative acute cardiac failure due to rapid opening of the bypassed vessel, and the symptom was resolved immediately through prompt management, while the others were not eventful during or post-operation. The length of artificial vessel required was 6 to 8 cm, and all patients had no graft vessel thrombosis after 10 to 55 months follow-up. In group B, one patient had intraoperative acute pericardial tamponment due to anastomotic leakage. The total occurrence rate of postoperative complication was 27.8%, including three pleural effusions, one pulmonary infection and one acute pericarditis. The length of the artificial vessel required was 12 to 14 cm. Three patients had graft vessel thrombosis at 37, 42 and 58 months post-operation, respectively.ConclusionsThe abdominal approach for suprahepatic and retrohepatic cavocaval bypass have advantages as follows over the traditional thoracolaparotomic approach for cavoartrial bypass: 1) Less traumatic with fewer postoperative thoracic and pulmonary complications; 2) A shorter artificial vessel required to facilitate endothelial seeding for improved long term patency; 3) Void of risk of fatal pericardial tamponment; 4) Prevention of acute pericarditis due to pericardial irritation by the artificial vessel in the thoracolaparotomic approach. We concluded that this novel abdominal approach is a safe and effective technique for treatment of SSOR-IVC.
BackgroundIn this animal study, we evaluated a modified pancreas perfusion method to improve the quality of harvested pancreas in rats. In this model, the portal vein was used as the outflow route during the pancreas perfusion.MethodsForty-eight male Wistar rats were randomly divided into study group and control group, with 24 rats in each group. In the study group, the portal vein was used as outflow of perfusion. While in the control group, the post-hepatic vein (right artrium) was used as perfusion outflow. UW solution was used as perfusion and preservation solution. Pancreas tissue samples were collected at 6, 10, and 14 hours after perfusion and cold preserved for histology and immunohistochemistry examination, P-selection (PS) and ICAM-1 were determined. Pancreas samples were also examined using electronic microscope for ultra-structures.ResultsCompared with the study group, in the pancreas of control group there were significant pathological impairments and cellular ultra-structural alterations observed by immunohistochemistry and electronic microscope, and these impairments aggravated with time. There were mild histological alterations in the pancreas of study group.ConclusionsDuring the donor pancreas perfusion, the early opening of portal vein as the outflow is better than the opening of the post-hepatic vein for the preservation of donor graft pancreas and the reduction of tissue impairments.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.