DOP28 Medical and Surgical Outcomes in Isolated Internal Penetrating Crohn’s Disease: A Multi-Centre Experience

Abstract Background Isolated internal penetrating Crohn’s diseases (IIPCD) is the second most common fistulating phenotype yet remains poorly characterised in therapeutic trials. This study assessed long-term outcomes of IIPCD. Methods We performed a retrospective study on data collected from 6 IBD referral centres, screening imaging reports between January 2016 and April 2019, excluding perianal or enterocutaneous fistulation, resulting in 121 patients with IIPCD. Management was classified as no intervention, medical (new/optimised) or surgical. The primary endpoint was complete resolution (CR) of fistula at next two imaging reassessments, paired with symptom and nutrition status, as previously defined(Samimi et al., 2010). Secondary endpoint was combined CR and partial resolution (PR). Statistics: Fisher’s exact, Kaplan-Meier method (SPSS v.27). Results Of patients at IIPCD diagnosis, 21% had previous IBD-related surgery, 21% were on a current biologic, 41% immunomodulator and 41% no treatment. Fistulae were majority enteroenteric (55%) and enterocolonic (48%), minority genitourinary (7.4%), with median disease duration at IIPCD diagnosis of 64 months. Outcomes of 118 patients with ≥1 interval imaging were analysed. Initial management was: 25.4% (n=30) no intervention, 49.2% (n=59) medical, 25.4% (n=30) surgical. Of fistula characteristics, only abscess predicted surgery over medical management (OR 5.30, 95% CI 1.60–15.48 p=0.0061), Figure 1. At first reassessment, CR and PR for the three management cohorts was 13.3%, 12.1%, 66.7% and 20.0%, 46.6%, 26.7%, respectively. The cumulative probability of CR was significantly greater for surgery compared with no intervention and medical management (log-rank p<0.001), Figure 2, and sustained when excluding pre-existing biologic (log-rank p=0.007), Figure 3, or previous surgery history (log-rank p<0.001). As observed management was then adjusted, cohorts were re-stratified: 13.5% (n=16) no intervention only, 45.8% (n=54) any medical but no surgery, 40.7% (n=48) any surgery. At second reassessment, again surgery significantly predicted CR over other management (log-rank p<0.001), Figure 4, but this was lost using the less strict outcome of combined CR and PR (log-rank p=0.447). No baseline variables were predictive of CR by each management. 27.6% (16/58) and 6.7% (2/30) of initial medical and no intervention cohorts had subsequent surgery (median interval 6.7 and 50.1 months) but there was no significant difference in peri-operative parenteral nutrition or post-operative intra-abdominal septic complication rates between earlier or later surgery. Conclusion In this cohort, surgery increases the probability of resolution of IIPCD with medical therapy including biologics offering limited temporising effect.

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Long-term functional outcomes of different subtypes of primary congenital glaucoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315131 ◽

2019 ◽

pp. bjophthalmol-2019-315131 ◽

Cited By ~ 2

Author(s):

Richard Sher Chaudhary ◽

Amisha Gupta ◽

Ajay Sharma ◽

Shikha Gupta ◽

Rayees Ahmad Sofi ◽

...

Keyword(s):

Visual Acuity ◽

Congenital Glaucoma ◽

Cumulative Probability ◽

Primary Congenital Glaucoma ◽

Visual Outcomes ◽

Post Surgery ◽

Kaplan Meier ◽

Significant Difference

AimTo analyse long-term visual outcomes across different subtypes of primary congenital glaucoma (PCG).MethodsPatients with PCG with a minimum of 5-year follow-up post surgery were included in the study. Snellen visual acuity recordings taken at their last follow-up were analysed. We evaluated the results using Kaplan-Meier curves to predict the probability of maintaining good vision (as defined by a visual acuity of 6/18 or better) in our patients after 30-year follow-up. The results were also analysed to determine whether there were any differences in the long-term visual acuities with time between the neonatal and infantile PCG. We also analysed the reasons for poor visual outcomes.ResultsWe assessed a cohort of 140 patients with PCG (235 eyes) with an average follow-up of 127±62.8 months (range 60–400 months). Overall, the proportion of eyes with good visual acuity was 89 (37.9%), those with fair visual acuity between 6/60 and 6/18 was 41 (17.4%), and those with poor visual acuity (≤6/60) was 105 (44.7%). We found a significant difference (p=0.047) between neonatal and infantile patients with PCG whereby the neonatal cohort fared worse off in terms of visual morbidity. On Kaplan-Meier analysis, the cumulative probability of survival of a visual acuity of 6/18 or better was more among the infantile PCG in comparison to the neonatal PCG (p=0.039) eyes, and more among the bilateral than the unilateral affected eyes (p=0.029). Amblyopia was the most important cause for poor visual acuity as shown on a Cox proportional-hazards regression model .ConclusionsLong-term visual outcomes of infantile are better than neonatal PCG. Eyes with unilateral have worse visual outcomes compared with those with bilateral PCG because of the development of dense amblyopia.

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Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽

10.1136/openhrt-2020-001440 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001440

Author(s):

Shameer Khubber ◽

Rajdeep Chana ◽

Chandramohan Meenakshisundaram ◽

Kamal Dhaliwal ◽

Mohomed Gad ◽

...

Keyword(s):

Coronary Artery ◽

Surgical Management ◽

Medical Management ◽

Cox Regression ◽

Artery Bypass ◽

Management Strategies ◽

Coronary Artery Aneurysms ◽

Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

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Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

Journal of Clinical Medicine ◽

10.3390/jcm10102054 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2054

Author(s):

Gerasimos Kopsinis ◽

Dimitrios Tsoukanas ◽

Dimitra Kopsini ◽

Theodoros Filippopoulos

Keyword(s):

Mitomycin C ◽

Primary Outcome ◽

Randomized Study ◽

Primary Outcome Measure ◽

Complication Rates ◽

Filtration Surgery ◽

Significant Difference ◽

Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

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Short and Long Term Outcome In Patients with Calcified Lesions Requiring Rotational Artherectomy

Bangladesh Heart Journal ◽

10.3329/bhj.v35i2.52901 ◽

2021 ◽

Vol 35 (2) ◽

pp. 140-146

Author(s):

Lima Asrin Sayami ◽

Al Fazir Omar ◽

Sheikh Ziarat Islam ◽

Subasni Govindan ◽

Zulaikha Zainal ◽

...

Keyword(s):

P Value ◽

Success Rates ◽

Term Outcome ◽

Long Term Outcome ◽

Operator Experience ◽

Kaplan Meier ◽

Significant Difference ◽

Short And Long Term ◽

Procedural Success

Objective: Despite the evolution of interventional techniques and operator experience, percutaneous revascularization of complex coronary lesions especially calcified lesions remains challenging because of lower procedural success and higher restenosis rates. Limited data are available on the effect of rotational atherectomy (RA) plus stenting in the treatment of complex calcified lesions of coronary artery disease. This study was aimed to investigate the characteristics, short and long term outcomes in patients undergoing RA. Material and Methods: A database search was performed from the year 2008 to 2013 in National Heart institute, Malaysia. A total of 16009 patients who underwent PCIs were enrolled in 2 groups, RA group (258 patients) and non RA group (15751 patients). The Chi square test and Kaplan - Meier analysis were used. Results: Male patients (73.6%) and elderly population (63.2%) were predominant in this study.The RA group had more co-morbidities such as diabetic on insulin (34%) and chronic kidney disease (57%). The lesions in RA group were more complex with higher Type C lesion (68.8%) and longer lesion (20.6%) compared to non RA group. Despite higher patient risk profile, the success rate of revascularization remains high in RA group (99.3%) as in non RA group (97%) (p value 0.89%). More importantly there were no significant difference in in-hospital mortality, myocardial infarction and stent thrombosis in both group (p value 0.1). In 1 year Kaplan - Meier survival graph, there were better survival noted in non RA group (97.7%) compare to RA (89.6%) (p value <0.005), Conclusion: The use of RA allows debulking of a calcified lesion and possibly explains the higher acute procedural success rates. However, the lower 1-yearsurvival in the RA group highlights the higher associated baseline comorbitidity in this group. Therefore, besides coronary intervention, this RA group requires aggressive medical therapy through a multi-disciplinary approach. Bangladesh Heart Journal 2020; 35(2) : 140-146

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Native Arterio-Venous Fistula for Hemodialysis: What to Expect Early after Creation?

The Journal of Vascular Access ◽

10.1177/112972980300400202 ◽

2003 ◽

Vol 4 (2) ◽

pp. 39-44 ◽

Cited By ~ 7

Author(s):

M. Leblanc ◽

E. Saint-Sauveur ◽

V. Pichette

Keyword(s):

Blood Flow ◽

Vascular Access ◽

Complication Rates ◽

Ultrasound Dilution ◽

Flow Monitoring ◽

Significant Difference ◽

Lower Complication ◽

Vascular Mapping ◽

Venous Fistula

Native arterio-venous fistulas (AVFs) are preferred for hemodialysis vascular access over synthetic grafts and long-term catheters. However, prevalence rates of native AVFs are variable around the world and have increased only slightly in United States since the DOQI guidelines. To increase rates of native AVFs, pre-operative vascular mapping by ultrasound has been found of major help for appropriate selection of the vessels. The minimal desirable lumen diameter of the artery should be > 2 mm and > 2.5 to 3 mm for the vein at the anatomosis. Early failure can be reduced to less than 10% when the feeding artery is > 2 mm, even in diabetics. If sizes of the vessels are smaller than those targets at the wrist, moving to the upper arm should be considered. The interval between creation and first cannulation varies from 2 weeks to 4 months. There might not be much advantage to wait for more than 4 weeks; however, in large dialysis units, observing a delay of 4 to 6 weeks may be worthwhile to avoid initial problems such as infiltrations and lacerations. Access flow monitoring is essential since it is a reliable predictor of vascular access dysfunction, reducing associated morbidity and costs. Early monitoring of recently created native AVFs has shown that the increase in intra-access blood flow occurs very soon after construction and becomes maximal after a few weeks. A recent prospective study involving all new native AVFs monitored by ultrasound-dilution between weeks 6 and 10 after creation, and every 3 to 6 weeks over 4 months, showed no statistically significant difference in access blood flow between the initial and final measurements (respective values of 1132 ± 681 and 1097 ± 644 ml/min). Access flow was higher in males, and in brachio-cephalic compared to radio-cephalic AVFs. Over the long-term, AVFs are associated with longer patency and lower complication rates, and efforts should be directed at further increasing their prevalence.

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Reinforcement Rings for Deficient Acetabular Bone in Revision Surgery: Long-Term Results

Hip International ◽

10.1177/112070009700700206 ◽

1997 ◽

Vol 7 (2) ◽

pp. 57-64 ◽

Cited By ~ 6

Author(s):

E. Garcia-Cimbrelo ◽

J. Alonso-Biarge ◽

J. Cordero-Ampuero

Keyword(s):

Revision Surgery ◽

Clinical Results ◽

Long Term Results ◽

Cumulative Probability ◽

Metal Ring ◽

Kaplan Meier ◽

Medial Migration ◽

Cemented Cup

This study analyzes the long-term results of 23 metal ring supports used in revision surgery since 1979. Only a metallic ring and a cemented cup were used in this series. Bone grafts and cementless cups were excluded from this study. One deep infection was excluded from the follow-up study. In the 22 cases analyzed, the mean follow-up period was 10 years for all cases and 12.2 years for unrevised cases. Bone defects according to the AAOS classification were: Grade 1, 1 case, Grade 2, 1 case, Grade 3, 10 cases, and Grade 4, 10 cases. A Müller ring was indicated in an anterior or medial wall defect (12 cases) and a Burch-Schneider ring was indicated in an anterior or posterior column defect or in pelvic discontinuity (10 cases). The clinical results were good in 8 cases, fair in 8 cases, and poor in 6 cases. Six cases were rerevised or removed, resulting in a total cumulative probability of rerevison or removal of 23.8% after 10 years according to the Kaplan-Meier analysis. Postoperatively, 18 cases had neutral rings, 2 cases had horizontal rings, and 2 cases had vertical rings. Radiological cup migration was found in 12 cases, resulting in a total cumulative probability of migration of 56.8% after 13 years according to the Kaplan-Meier analysis. Changes in the acetabular angle were present in 2 cases, vertical migration in 12 cases, and medial migration in 10 cases. Our data suggest that the metal ring and cemented cup alone could be used for salvage surgery in elderly patients and in low-demand patients. Possibly, adding bone graft could improve these results.

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Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review

Canadian Urological Association Journal ◽

10.5489/cuaj.6786 ◽

2020 ◽

Vol 15 (5) ◽

Author(s):

Sarah Neu ◽

Jennifer Locke ◽

Mitchell Goldenberg ◽

Sender Herschorn

Keyword(s):

Patient Characteristics ◽

Urethral Diverticulum ◽

Pelvic Surgery ◽

Study Patient ◽

Complication Rates ◽

Urethrovaginal Fistula ◽

Fascial Sling ◽

Significant Difference ◽

Sling Placement

Introduction: We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. Methods: All patients diagnosed with UVF at our center from 1988–2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. Results: A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35–62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4–72). Conclusions: UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.

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Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Journal of Neurosurgery ◽

10.3171/2014.10.jns132369 ◽

2015 ◽

Vol 122 (2) ◽

pp. 392-399 ◽

Cited By ~ 56

Author(s):

Xing-ju Liu ◽

Dong Zhang ◽

Shuo Wang ◽

Yuan-li Zhao ◽

Mario Teo ◽

...

Keyword(s):

Clinical Features ◽

Moyamoya Disease ◽

Positive Impact ◽

Chinese Patients ◽

Single Center ◽

Long Term Outcomes ◽

Kaplan Meier ◽

Significant Difference ◽

Revascularization Procedures

OBJECT The aim of this study was to describe the baseline clinical features and long-term outcomes of patients with moyamoya disease (MMD) based on a 25-year period at a single center in China. METHODS Data obtained in 528 consecutive patients with MMD treated at the authors' hospital from 1984 to 2010 were reviewed retrospectively. Events of transient ischemic attack, new infarction, and hemorrhage were included. The Kaplan-Meier risk of stroke was calculated. RESULTS The mean (± SD) patient age was 26 ± 13 years (range 2–67 years), and the female/male ratio was 0.9:1. There were 332 cases of ischemia and 196 hemorrhages. Adults had a higher rate of bleeding than children (50.7% vs 14.0%, respectively; p < 0.001). One hundred twenty-two patients were treated conservatively, and 406 patients underwent revascularization procedures. Of 528 patients, 331 (62.7%) had at least 1 year of follow-up (median 39.5 months) and data from these patients were analyzed. Rebleeding and mortality rates in patients with hemorrhagic MMD (n = 104) were higher than in those with ischemic MMD (n = 227) (26.9% vs 2.2% [p < 0.001] and 4.8% vs 0.4% [p < 0.05], respectively). Twenty-five of 60 (41.7%) conservatively treated patients and 8 of 271 (2.9%) surgically treated patients experienced rebleeding events, a difference that was significant in the Kaplan-Meier curve of rebleeding (p < 0.01). An improvement in perfusion was found in 164 of 224 (73.2%) surgically treated patients 1 month after discharge. However, there was no significant difference in the rate of ischemic events in the surgical and conservative groups (18.8% and 28.3%, respectively; p = 0.09). Among the 104 hemorrhagic cases, rebleeding attacks were observed in 25 patients in the nonsurgical group (n = 60) and 3 patients in the surgical group (n = 44) (41.7% and 6.8%, respectively; OR 9.7 [95% CI 2.7–35.0]; p < 0.01). CONCLUSIONS There was no difference in the sex distribution of Chinese patients with MMD. Patients with hemorrhagic MMD had a much higher rate of rebleeding and poorer prognosis than those with the ischemic type. Surgical revascularization procedures can improve cerebral perfusion and have a positive impact in preventing rebleeding in patients with hemorrhagic MMD.

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Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

The American Surgeon ◽

10.1177/000313481708300723 ◽

2017 ◽

Vol 83 (7) ◽

pp. 696-698 ◽

Cited By ~ 1

Author(s):

Thomas S. Easterday ◽

Joshuaw Moore ◽

Meredith H. Redden ◽

David V. Feliciano ◽

Vernon J. Henderson ◽

...

Keyword(s):

Trauma Registry ◽

Percutaneous Tracheostomy ◽

Trauma Patients ◽

Complication Rates ◽

Short Term ◽

Significant Difference ◽

Urban Level ◽

Level I ◽

Bronchoscopic Guidance

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

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Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

Surgical Endoscopy ◽

10.1007/s00464-019-07364-y ◽

2020 ◽

Vol 35 (1) ◽

pp. 104-112

Author(s):

Vilja Koskensalo ◽

Marianne Udd ◽

Mia Rainio ◽

Jorma Halttunen ◽

Matias Sipilä ◽

...

Keyword(s):

Abdominal Pain ◽

University Hospital ◽

Long Term Results ◽

Biliary Duct ◽

Complication Rates ◽

Biliary Sphincterotomy ◽

Significant Difference ◽

Upper Abdominal

Abstract Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

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