A Prospective Clinical Study Evaluating the Development of Bowel Wall Edema During Laparoscopic and Open Visceral Surgery

Marjanović, Goran; Kuvendziska, J; Holzner, Philipp; Glatz, Torben; Sick, Olivia; Seifert, Gabriel; Kulemann, Birte; Küsters, Simon; Fink, Jodok; Timme, Sylvia; Hopt, Ulrich T.; Wellner, Ulrich; Keck, Tobias; Karcz, Wojciech Konrad

doi:10.1007/s11605-014-2681-3

Cited by 11 publications

(7 citation statements)

References 35 publications

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“…The functional cause, however, remains an issue of debate. As a potential mechanism, a prospective study by Marjanovic et al found a reduction of postoperative bowel edema in patients undergoing LPD compared to OPD, reducing postoperative impaired bowel movement and peristaltic 28 .…”

Section: Discussionmentioning

confidence: 99%

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Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

et al. 2018

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Background Laparoscopic pancreatoduodenectomy is a highly challenging procedure. The aim of this study was to analyse post-operative morbidity and mortality as well as long term overall survival in patients undergoing hybrid LPD, as compared to open pancreaticoduodenecomy (OPD) in a single surgeon series. Methods Patients undergoing pancreatoduodenectomy (PD) in the period from 2000 to 2015 were identified from a prospectively maintained database. All LPD procedures were performed by one specialised pancreatic surgeon (TK). Patients were matched 1 : 1 for age, sex, BMI, ASA, histological diagnosis, pancreatic texture and portal venous resection (PVR). All LPD procedures were performed as hybrid LPD – combining laparoscopic resection and open reconstruction via mini laparotomy. Results A total of 549 patients were identified, including 489 patients in the OPD group and 60 patients in the LPD group. 60 patients were identified who underwent LPD between 2010 and 2015 versus 60 OPD patients operated in the same period. Median overall operation time was shorter in the LPD group than with OPD patients (LPD 352 vs. OPD 397 min; p = 0.002). Overall transfusion units were lower in the LPD group (LPD range 0 – 4 vs. OPD range 0 – 11; p = 0.032). Intensive care unit stay (LPD 1 vs. OPD 6 d; p = 0.008) and overall hospital stay (OHS: LPD 14 vs. OPD 18 d; p = 0.012) were shorter in the LPD groups than in the OPD group. As regards postoperative complications, LPD was associated with reduced rates of clinically relevant grade B/C postoperative pancreatic fistula (LPD 15 vs. OPD 36%; p = 0.036) and grade B/C delayed gastric emptying (LPD 8 vs. OPD 20%; p = 0.049). A total of 56 patients were diagnosed with malignant disease. The number of harvested lymph nodes and R0-resection rates were equal for LPD and OPD patients. LPD patients showed a trend to improved median overall survival (LPD mean 56 months vs. OPD mean 48 months; p = 0.056). Conclusion Hybrid LPD is a safe procedure associated with a reduction in clinically relevant postoperative complications and allows faster recovery. Long term oncological outcome of hybrid LPD for malignant disease is equal to that with the standard open approach.

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Section: Discussionmentioning

confidence: 99%

“…Mögliche Gründe werden aktuell kontrovers diskutiert. Als potenzielle Ursache konnten Marjanovic et al in einer prospektiven Studie eine Reduktion der postoperativen gastrointestinalen Ödembildung bei LPD-Patienten im Vergleich zu OPD-Patienten zeigen, dies führte zu geringeren Einschränkungen von Peristaltik und Darmmotilität 28 .…”

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Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

et al. 2018

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“…We suspect that the development of bowel wall edema would have contributed to the difference in the incidence of POPF between the two groups. Marjanovic et al showed the beneficial effects of laparoscopic surgery versus open visceral surgery in preventing bowel wall edema [ 30 ] and concluded that prevention of bowel wall edema formation is an advantage of minimally invasive surgery with respect to anastomotic healing. Hiki et al showed that postoperative inflammation is less pronounced after laparoscopic procedures than after open surgery [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Laparoscopic versus Open Pancreaticoduodenectomy for Ampulla of Vater Carcinoma

Yoo

Song

Lee

et al. 2020

JCM

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Several studies have compared laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with periampullary carcinoma; however, only a few studies have made such a comparison on patients with ampulla of Vater cancer (AVC). We compared the perioperative and oncologic outcomes between LPD and OPD in patients with AVC using propensity-score-matched analysis. A total of 359 patients underwent PD due to AVC during the study period (76 LPD, 283 OPD). After propensity score matching, the LPD group showed significantly longer operation time than did the OPD group (400.2 vs. 344.6 min, p < 0.001). Nevertheless, the LPD group had fewer painkiller administrations (8.3 vs. 11.1, p < 0.049), fewer Grade II or more severe postoperative complications (15.9% vs. 34.8%, p = 0.012), and shorter postoperative hospital stays (13.7 vs. 17.3 days, p = 0.048), compared with the OPD group. There was no significant difference in recurrence-free outcomes and overall survival between the two groups (p = 0.754 and 0.768, respectively). Compared with OPD, LPD for AVC had comparative oncologic outcomes with less pain, less postoperative morbidity, and shorter hospital stays. LPD may serve as a promising alternative to OPD in patients with AVC.

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“…Most surgeons recognise from experience that the development of bowel wall oedema plays a key role in anastomotic failure. One comparative study evaluated the development of bowel wall oedema during laparoscopic and open visceral surgeries, showing that laparoscopic surgery is associated with lower rates of this finding 33 . The authors concluded that prevention of bowel wall oedema may be one advantage of minimally invasive surgery, as it leads to faster anastomotic healing.…”

Section: Discussionmentioning

confidence: 99%

Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients

Shin

Song

Kim

et al. 2019

Sci Rep

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There is little evidence on the safety and benefits of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients; therefore, we evaluated the feasibility and efficacy of this procedure by comparing perioperative and oncological outcomes between LPD and open pancreaticoduodenectomy (OPD) in elderly patients. We retrospectively reviewed the data of 1,693 patients who underwent PD to manage periampullary tumours at a single institution between January 2014 and June 2017. Of these patients, 326 were elderly patients aged ≥70 years, with 56 patients allocated to the LPD group and 270 to the OPD group. One-to-one propensity score matching (56:56) was used to match the baseline characteristics of patients who underwent LPD and OPD. LPD was associated with significantly fewer clinically significant postoperative pancreatic fistulas (7.1% vs. 21.4%), fewer analgesic injections (10 vs. 15.6 times; p = 0.022), and longer operative time (321.8 vs. 268.5 minutes; p = 0.001) than OPD in elderly patients. There were no significant differences in 3-year overall and disease-free survival rates between the LPD and OPD groups. LPD had acceptable perioperative and oncological outcomes compared with OPD in elderly patients. LPD is a reliable treatment option for elderly patients with periampullary tumours.

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A Prospective Clinical Study Evaluating the Development of Bowel Wall Edema During Laparoscopic and Open Visceral Surgery

Abstract: Laparoscopic surgery does not seem to lead to the bowel wall edema observed to occur in open surgery regardless of the degree of intravenous fluid administration, thus supporting its use even in major visceral surgery.

Cited by 11 publications

References 35 publications

Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

A Comparative Study of Laparoscopic versus Open Pancreaticoduodenectomy for Ampulla of Vater Carcinoma

Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients

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