Emergency pancreatic surgery—demanding and dangerous

Strobel, Oliver; Schneider, Lutz; Philipp, Sebastian; Fritz, Stefan; Büchler, Markus W.; Hackert, Thilo

doi:10.1007/s00423-015-1321-z

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…Thus, collection of data about the presence/ absence of hepatitis viruses have been proposed to further explore the potential effect of such viruses on clinical, pathological and outcomes in patients with PD for periampullary malignancies starting from our previous research suggesting that there might be some influences of hepatitis viruses on clinical and pathological features particularly for patients with pancreatic cancer (54) as it was shown for hepatocellular carcinoma (55). Furthermore, the elective or emergency indication for PD was also pointed out because, although a PD in an emergency setting is feasible (56), it is widely accepted to be associated with very high mortality rates (around 34.7%) even in high-volume centers (57). In the present series, there was one postoperative death out of the 3 patients with emergency PD (mortality rate of 33.3%), but the cause of death was not related to pancreatic surgery complications.…”

Section: Discussionmentioning

confidence: 98%

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

Bartoș¹,

Ionescu²,

Iancu³

et al. 2018

chr

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National databases for pancreaticoduodenectomies (PD) have contributed to better postoperative outcomes after such complex surgical procedure because the multicentre collection of data allowed more reliable analyses with quality assessment and further improvement of technical issues and perioperative management. The current practice and outcomes after PD are poorly known in Romania because there was no national database for these patients. Thus, in 2016 a national-intent electronic registry for PD was proposed for all Romanian surgical centers. The study aims to present the preliminary results of this national-intent registry for PD after one-year enrollment. Patients The database was started on October 1st, 2016. Data were prospectively collected with an electronic online form including 102 items for each patient. The registry was opened to all the Departments of Surgery from Romania performing PD, with no restriction. During the first year of enrollment were collected the data of 181 patients with PD performed by 24 surgeons from four surgical centers. The age of patients was 64 years (28 - 81 years), with slightly male predominance (61.3%). Computed tomography was the main preoperative imaging investigation (84.5%). All the PDs were performed by an open approach. The Whipple technique was used in 53% of patients, and a venous resection was required in 14.3% of cases. A posterior approach PD was considered in 16.6% of patients. The stomach was used to treat the distal remnant pancreas in 50.1% of patients. The operative time was 285 min (110 - 615 min), and the estimated blood loss was 400 ml (80 - 3000 ml). The overall morbidity rate was 55.8%, with severe (i.e., grade III-IV Dindo-Clavien) morbidity rate of 10%, and 3.9% in-hospital mortality rate. The overall pancreatic fistula, delayed gastric emptying and hemorrhage rates were 19.9%, 39.8% and 15.5%. Periampullary malignancies were the main indications for PD (78.9%), with pancreatic cancer on the top (48%). To build a prospective electronic online database for PD in Romania appears to be a feasible project and a useful tool to know the current practice and outcomes after PD in our country. However, improvements are still required to encourage a larger number of surgical centers to introduce the data of patients with PD.

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Section: Discussionmentioning

confidence: 98%

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

Bartoș¹,

Ionescu²,

Iancu³

et al. 2018

chr

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“…Reports of mortality following pancreatic injury have ranged from 12 to 35%. 9,28 The previously discussed review of the National Trauma Data Bank for pediatric blunt pancreatic trauma found a mortality of 2.5%, specifically for operatively managed patients, and 6.7% for nonoperatively managed patients. 24 Cause of death also did not differ significantly between the pediatric and adult populations, likely due to the overall low mortality rate in our data.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Traumatic Pancreatic Injuries in Pediatric and Adult Patients: A Retrospective Study Involving Four Trauma Centers

Iurcotta

Addison

Amodu

et al. 2017

JCS

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Traumatic injuries of the pancreas are rare and affect both children and adults. Very little has been done to investigate differences in outcome between these two age groups. We performed a retrospective review of cases in four trauma hospitals to determine the differences in outcomes between pediatric and adult patients with traumatic pancreatic injuries. A retrospective chart review was performed for 69 pediatric and adult patients seen at four trauma centers in our health system between 1990 and 2014. The Mann–Whitney's U-test was used to compare continuous variables, while the chi-square and Fisher's exact tests were used for categorical variables. Mortality was determined using the Social Security Death Master File. In this study, 26 pediatric and 43 adult patients were included. Median ages were 11.4 and 42.3 years, respectively. There were significant differences in mechanism of blunt injury between pediatric and adults (motor vehicle collisions = 17.4 vs. 64.9%, bicycle accidents = 43.5 vs. 0.0%; p-value for both comparisons < 0.0001), median injury severity score (6.5 vs. 12; p = 0.030), surgical management (30.8 vs. 67.4%; p = 0.003), and postinjury pancreatitis (57.7 vs. 20.9%; p = 0.002). Median hospital length of stay was 5 versus 11 days (p = 0.005), respectively. There were no differences in mortality or other complications. In spite of significant differences in blunt injury type, injury severity, and the need for surgery, there were no significant differences in mortality or most postinjury complications between pediatric and adult patients with traumatic pancreatic injuries.

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“…A surgical team familiar with HPB surgery can adapt to the emergency situation and also provide better postoperative care because it is customized with post-op complications and can treat them accordingly. Interdisciplinary communication and expertise can provide better outcomes (6,7).…”

Section: Discusionsmentioning

confidence: 99%

“…Prognosis depends on the timing to intervention, the experience of the operating surgeon, on the peri-and postoperative anesthesiological management and on the radiological management of postoperative complications (6,7).…”

Section: Discusionsmentioning

confidence: 99%

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

Eftimie¹,

Lungu²,

Tudoroiu³

et al. 2017

chr

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RezumatDuodenopancreatectomia efectuatã în urgenţã este o procedurã chirurgicalã rarã şi ca urmare puţine cazuri sunt prezentate în literaturã. Este un abord folosit în puţine cazuri, fiind indicat în tratamentul chirurgical de urgenţã al traumelor abdominale ce implicã regiunea cefalopancreaticã sau duodenul, fiind şi o unealtã utilã în tratamentul anevrismelor rupte, pseudochistelor hemoragice, perforaţiilor duodenale, hemoragiei necontrolate de la nivelul ulcerelor sau tumorilor duodenale, complicaţiilor septice severe ale pancreatitei acute şi în tratamentul complicaţiilor secundare manevrelor asociate colangiopancreatografiei retrograde (1,2). Este folositã în puţine cazuri ca şi primã linie de tratament chirurgical al sângerãrilor acute datorate pseudoanevrismelor rupte ale arterelor regiunii cefalopancreatice. Prezentãm cazul unei sângerãri acute de la nivelul unui pseudoanevrism al regiunii cefalopancreatice prezent la un pacient tânãr cu pancreatitã cronicã, nediagnosticatã pânã la momentul debutului bolii şi la care s-a ridicat suspiciunea unei formaţiuni tumorale a regiunii cefalopancreatice. Am efectuat o duodenopancreatectomie cu rezecţie de venã mezentericã superioarã şi de venã portã cu reconstrucţie venoasã folosind grefon sintetic de Gore-Tex® datoritã posibilei invazii tumorale la nivel venos. Evoluţia postoperatorie a fost marcatã de apariţia unei fistule pancreatice minore, remisã sub tratament conservator. Concluzionãm cã acest abord este util în tratamentul acestor cazuri atât ca primã linie de tratament sau secundar abordului endovascular (stentare sau embolizare).Cuvinte cheie: duodenopancreatectomie cefalicã, rezecţie vascularã, rezecţie pancreaticã în urgenţã, reconstrucţie vascularã Abstract Emergency pancreatico-duodenectomy(EPD) is a very rare procedure and few reports are present in medical literature. It is an uncommon approach, usually

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Emergency pancreatic surgery—demanding and dangerous

Cited by 22 publications

References 26 publications

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

An Attempt to Build a National Prospective Electronic Database for Pancreaticoduodenectomies in Romania - Preliminary Results of the First Year Enrollment

Outcomes of Traumatic Pancreatic Injuries in Pediatric and Adult Patients: A Retrospective Study Involving Four Trauma Centers

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft

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