Early surgery to avoid PBD is possible within the NHS. By reducing the time to surgery it appears that more patients undergo potentially curative resection. It is desirable to understand why surgery without PBD is not performed routinely as are the development of strategies to support its more widespread practice.
Background: To estimate results of the organ-preserving pancreatic resections. Methods: Duodenum-preserving pancreatic head resection (DPPHR) was performed in 24 pts with serous (6) and mucinous (6) cystadenomas, branch-duct intraductal papillary mucinous tumors (7), neuroendocrine adenoma (4) and metastatic renal cell carcinoma (1). Alimentary tract reconstruction was performed by pancreatojejunostomy (Roux-en-Y) (21) or pancreatogastrostomy (3). Laparoscopic approach was chosen in 7 cases. Pancreatic head resection combined with segmental duodenectomy (PHRSD) was performed in 22 pts with chronic pancreatitis complicated by duodenal dystrophy (20) and with large serous cystadenoma (2). Alimentary tract reconstruction was performed by duodenoduodenostomy combined with pancreaticojejunostomy and choledochojejunostomy (Roux-en-Y) (7); pancreatogastrostomy and choledochoduodenostomy (13); pancreaticooduodenostomy duct-to-mucosa and choledochoduodenostomy (2). Results: Ischemia of duodenum didn't note in one case. Postoperative complication constituted the following: bile duct stricture (3) and postoperative bleeding (1) in DPPHR, delayed gastric emptying (2) and postoperative bleeding (1) in PHRSD. Newly developed diabetes mellitus occurred in 2 pts. Exocrine pancreatic insufficiency was observed in 2 pts with chronic pancreatitis. There was no hospital mortality. Conclusion: DPPHR is recommended for a benign pancreatic head lesion. PHRSD can be an option for a lesion of the duodenal area and the pancreatic head.
p = 0.59), pathological diagnosis (66% vs 71% pancreatic adenocarcinoma), vascular reconstruction (13% vs 14%, p = 0.857) or Charlson score (5.3 vs 4.7, p = 0.820). Pancreatic texture and duct diameter were similar. One mortality occurred in the ERAS group.The incidence of postoperative complications was identical. Grade B or C pancreatic fistulation occurred in 19% of patients in each group (p = 0.97) whilst delayed gastric emptying occurred in 22.2% vs 19.1% (p = 0.77). Unplanned readmissions was comparable (34.3% vs 38.6% p = 0.81) as was length of stay (18.8 days vs 17.7 days, p = 0.59). Conclusion: The implementation of an ERAS protocol failed to reduce the incidence of complications, unplanned readmissions or decrease the length of stay in patients undergoing PD.
Background Randomised trials have shown that preoperative biliary drainage (PBD) causes more harm than a straight to surgery approach for patients with jaundice and periampullary malignancy. However, it remains standard practice in many centres for jaundiced patients to undergo PBD. The aim of this study was to review the impact of a pathway to avoid PBD before pancreatoduodenectomy on clinical outcomes.
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