Completion pancreatectomy (CP), is an effective, and potentially curative option for selected patients with local recurrence of pancreatic neoplasms in the remnant pancreas after initial pancreatoduodenectomy (PD). Traditionally CP has been performed via the open approach. Reports of minimally-invasive CP particularly after previous open PD are rare. We present a case of a 72-year old male who previously underwent open PD 5 years ago for intraductal papillary mucinous neoplasm (IPMN) with high grade dysplasia in the uncinate process. He had multifocal IPMN and low-risk lesions in the body and tail were managed conservatively. On routine surveillance, the cyst in the body was noted to be increasing in size with the development of a non-enhancing solid component confirmed on magnetic resonance imaging and subsequent endoscopic ultrasonography. The patient underwent successful robotic assisted laparoscopic completion pancreatectomy. Final histology confirmed a recurrent IPMN with low-to-intermediate grade dysplasia. The postoperative recovery was uneventful and he was discharged on postoperative day 9.
Between 1994 to 2015, patients with GB cancer who received curative resection were reviewed and we found three UC cases. Result: The first 68-year-old man presented with body weight loss, febril and chilly sensation. Imaging studies revealed an 4.2x2.4-cm fungating mass in the fundus of the GB. Multiple hepatic and para-arotic lymph node metastasis was detected at postoperative 2 months and the patient died at 4 months after surgery. In the second case, a 72year-old man presented with abdominal pain and febrile sensation. On gross examination, a 15x10-cm tumor was originated from the gallbladder and directly invaded into liver, transverse colon, and omentum. Histological section revealed an UC and hepatic resection margin was involved by the tumor cell. Regional node metastasis was confirmed. Unfortunately, the patient diet at 50 day after surgery due to postoperative sepsis. The third case was a 65-year-old woman who presented with right upper quadrant abdomian pain. The patients was detected multiple hepatic and paraaortic lymph node metastasis at postoperative 2 months after surgery and was treated with systemic chemotherapy, but disease rapidly was progressed and the patient died at 6 months after surgery. Conclusion: Undifferentiated carcinoma of the gallbladder was a rare highly malignant neoplasms. It showed a large tumor pattern with involvement of adjacent organ and the prognosis was very poor.
Introduction: Although advances in multidisciplinary management reduce the mortality after pancreaticoduodenectomy (PD) from medical complications, postoperative pancreatic fistula (POPF) and/or postpancreatectomy haemorrhage (PPH) still remain as common morbidities and main causes of mortality. The morbidity of POPF and/or PPH after PD in our centre, Yangon Specialty Hospital, is 18-30% per year. And there are still ongoing disputes regarding management of POPF and/or PPH after PD. Methods: It is a hospital based prospective descriptive study carried out between 2018 January and 2020 April in surgical units at Yangon General Hospital, New Yangon General Hospital and our centre. Total 28 reoperated patients with POPF and/or PPH patients after PD were included in the study. The indications for reoperation in this study were patients with SIRS together with drain amount more than 300 ml/day and/or blood in drain/ NGT with Hb drop ≥ 3 g% or sentinel bleed. Preoperative CECT scan was done if condition was favorable. In this study, demographic distribution, proportion of reoperation, timing of reoperation, types of procedure were also recorded while outcomes of reoperation was emphasized in this eposter. Results: There were 56 patients who suffered from POPF and/or PPH after PD for periampullary carcinoma during this study period. Although reoperation was advised to 34 patients, who met the indications for reoperation, six of them declined operation for various reasons. Therefore, total 28 patients were reoperated (50%). Fig. 1 showed the intraoperative findings of POPF and PPH patient. Median timing of reoperation was 9 days (2-25 days) and 71% were reoperated within 10 days. While external tube wirsungosotmy (Fig. 2) was performed in majority of POPF cases as a damage control surgery, PPH patients ended up with mainly laparotomy and GDA ligation for arrest of haemorrhage because of lack of interventional radiology (IR) support at present.
Conclusions: It was suggested that the multichannel gene autoanalyzer is a new system for the rapid detection of causative bacteria in patients with infectious acute cholangitis and cholecystitis.
We report a Case of laparoscopic distal pancreatectomy for NET (neuroendcrine tumor) of a highly obese patient. A 69-year-old man with a body mass index (BMI) of 38 kg/m2 despite being 168cm tall and weighting 108kg, was reffered to our hospital for pancreatic tumor. A computed tomography (CT) scan revealed a tumor of pancreatic tail. OctoreoScan revealed abnormal uptake of SRS in it. NET was suspected; therefore, we performed Laparoscopic distal pancreatectomy. The operation time was 480 min, and blood loss was 420 ml. His postoperative course was uneventful and he was discharged 7 days after surgery. Laparoscopic surgery is the minimally invasive for obese patients in terms of abdominal wall distruction. Enlarged view suggest precise release layer lead to no complication and early discharge. We concluded that laparoscopic distal pancreatectomy is effective in a highly obese patient.
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