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Background Data are sparse regarding patient selection criteria or evaluating oncologic outcomes following laparoscopic pancreaticoduodenectomy (LPD). Having prospectively limited LPD to patients with resectable disease defined by National Comprehensive Cancer Network (NCCN) criteria, we evaluated perioperative and long-term oncologic outcomes of LPD compared to a similar cohort of OPD. Methods Consecutive patients (11/2010 – 02/2014) undergoing PD for periampullary adenocarcinoma were reviewed. Patients were excluded from further analysis for benign pathology, conversion to OPD for portal vein resection, and contraindications for LPD not related to their malignancy. Outcomes of patients undergoing LPD were analyzed in an intention-to-treat manner against a cohort of patients undergoing OPD. Results These selection criteria resulted in offering LPD to 77% of all cancer patients. Compared to the OPD cohort, LPD was associated with significant reductions in wound infections (16 vs. 34%; P = .038), pancreatic fistula (17 vs. 36%; P = .032) and median hospital stay (9 vs. 12 days; P = .025). Overall survival (OS) was not statistically different between patients undergoing LPD vs. OPD for periampullary adenocarcinoma (Median OS 27.9 vs. 23.5 mo; P = .955) or pancreatic adenocarcinoma (N = 28 vs. 22 patients; Median OS 20.7 vs. 21.1 mo; P = 0.703). Conclusions The selective application of LPD for periampullary malignancies results in a high degree of eligibility as well as significant reductions in length of stay, wound infections and pancreatic fistula. Overall survival after LPD is similar to OPD.

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It has been well-proven that prolonged immobilization is detrimental to synovial joints. For the past 5 years, in an effort to minimize these undesirable sequelae, we have treated 94 patients with major knee trauma by early protected motion. Acute ligament injuries not requiring surgery were placed in the cast brace immediately, while operated cases were started about the 10th postoperative day. Our method of cast bracing stresses proper alignment of the joints, security of limb position, prevention of swelling complications, and economy of physician time. A special feature is a modified single axis joint that restricts the arc of motion to safe limits, generally 30 to 90 degrees. Functionally, our results compare quite favorably with our previous traditionally treated experience. Rehabilitation times were markedly shortened, patient acceptance was high, and complications were rare. Early motion was extremely well-tolerated with only one cast removed because of discomfort. Postoperative effusion rapidly disappeared with commencement of motion. Rapid return of motion did not correlate with a poor result, and the stability of operated knees did not loosen with time. Although lack of controls precludes definitive comparisons, we conclude that early protected motion is safe and provides significant benefits.