Background
Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS.
Methods
The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.
Results
Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0–95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7–77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6–90.5) and 87.4% (95%-CI 81.2–91.8), respectively (P = 0.389).
Conclusions
Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.
M.I. Ionescu et al în literatură. Mai mult decât atât, reprezintă de asemenea primul caz de anastomoză arterială latero-terminală efectuată în cursul unui TH la un pacient cu THE. Lucrarea noastră demonstrează că această abordare este atât fezabilă din punct de vedere tehnic, cât şi sigură în context clinic. Cuvinte cheie: telangiectazie hemoragică ereditară, sindromul neoplaziei endocrine multiple tip 1, transplant hepatic ortotopic
First experience in transplantation in one center Methods: Critical epidemiological condition that has developed in Republic of Moldova due to prevalence and incidence of viral cirrhosis, and as a result high mortality rate caused by liver cirrhosis -76.46 per 100000 of population (first place in the world). This fact required us to launch the program of liver transplantation. The first liver transplantation in Republic of Moldova was performed on February 22nd, 2013. This surgical intervention was successful for the donor and recipient. The first liver transplant from the death brain donor was performed after one year, and it was successful for the recipient. Up to now, 12 liver transplantations have been performed in our country, 7 of them from living donors and 5 from death brain donors. The etiology of transplantated recipients was: HBV -2 cases, HBV+HDV -4 cases, HBV+HCV -2 cases, HBV + HDV+ hepatocellular carcinoma -1 case, HBV+ hepatocellular carcinoma -1 case, primitive biliary cirrhosis -1 case and 1 case of retransplantat. Results: Complications after liver transplantation were following: postoperative bleeding -1 case, thrombosis of hepatic artery -1 case, biliary peritonitis -1 case, acute rejection of graft -1 case and convulsive syndrome -1 case. The mortality in the early postoperative period was in 2 cases, mortality during the first year was 0. Causes of mortality were -postoperative intra-cerebral bleeding and acute rejection of the graft. In the postoperative period, living donors didn't have any complications. Average length of stay in case of living donor liver transplantation was 43 days and in death brain liver transplantation was 32 days. Conclusions: Necessary number of 40 liver transplants every year will be reached due to implementation of national program of transplant in Republic of Moldova.
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.