Late Biliary Complications after Pancreaticoduodenectomy

2016 ◽  
Vol 82 (5) ◽  
pp. 456-461 ◽  
Author(s):  
Pablo Parra-membrives ◽  
Darío Martínez-baena ◽  
Fabricio Sánchez-sánchez
Keyword(s):  
Management Strategies ◽  
Bile Leak ◽  
Late Complications ◽  
Biliary Complications ◽  
Intraoperative Blood Loss ◽  
Biliary Strictures ◽  
Biliary Leak ◽  
Afferent Limb ◽  
Operative Drainage

Since morbidity of pancreaticoduodenectomy (PD) has been improved, concerns about late complications have raised. We present a review of long-term biliary complications after PD attended at our institution. The data of 86 patients operated on from January 2001 to May 2014 were examined and incidence of late biliary complications was recorded. The preoperative features of the patients, timing of symptoms appearance, results of diagnostic imaging test, and the management strategies were analyzed. Late biliary complications occurred in 14 patients (16.3%). The median time to diagnosis was 9.50 months. The preoperative peak bilirubin level, need for pre-operative drainage and intraoperative blood loss were not significantly different for patients with long-term biliary events. Eight patients (57.14%) developed true biliary strictures. Three of them (37.5%) had experienced a postoperative biliary leak ( P < 0.0005) and resulted in benign strictures. The remaining five patients revealed tumor recurrence. Six patients had no biliary obstruction and cholangitis could only be explained through afferent-limb stasis. Late biliary strictures appear predominantly in the first postoperative year and develop more likely if a bile leak occurred in the postoperative period. However, biliary strictures are not always responsible for late biliary symptoms and afferent limb stasis may also be included in the differential diagnosis.

scholarly journals Incidence of biliary complications in living donor liver transplantation

2018 ◽  
Vol 6 (9) ◽  
pp. 3030
Author(s):  
Joseph Varghese
Keyword(s):  
Liver Transplantation ◽  
Biliary Stricture ◽  
Bile Leak ◽  
Biliary Complications ◽  
Sphincter Of Oddi Dysfunction ◽  
Biliary Strictures ◽  
Donor Liver ◽  
Biliary Leak ◽  
Donor Liver Transplantation ◽  
Live Donor Liver

Background: Liver transplantation is a widely accepted treatment for end stage liver diseases and selected cases of hepatocellular carcinoma, if it is limited to the liver. Biliary complications such as biliary strictures and bile leaks after the liver transplantation remain the major cause for morbidity and mortality. This study was aimed to estimate the incidence of biliary complications in live donor liver transplantation (LDLT) patients and the rate of radiological intervention in its management.Methods: Case records of LDLT patients during the past two years were retrospectively studied to estimate the incidence of biliary complications. Biliary complications were diagnosed based on clinical features like pain, fever, jaundice or increased bile from biliary drains. The patients were imaged using ultrasonogram, computed tomogram, magnetic resonance imaging or Endoscopic retrograde cholangiopancreatography (ERCP) for any biliary strictures and leaks, choledocholithiasis or sphincter of oddi dysfunction. The rate of ERCP and Percutaneous Trans Biliary Drainage (PTBD) interventions in these patients was recorded.Results: Fifty cases of post LDLT patients (both prospective and retrospective) were analysed in the study. The incidence of biliary stricture was 12% (6/50) and among the 6 patients with biliary stricture, 4 had bile leak. Among the total cases, the incidence of biliary leak was 8%. Eighty three percent of the biliary complications were managed by ERCP, whilst 17% by PTBD.Conclusions: The incidence of biliary stricture was 12% and biliary leak was 8%. The biliary complications were managed by ERCP in 83% and percutaneous approach in 17% of cases.

scholarly journals The Role of Endoscopy in the Treatment of Biliary Complications after Orthotopic Liver Transplantation

2019 ◽  
Vol 29 (1) ◽  
pp. 62-67
Author(s):  
Alexey V. Kurenkov ◽  
Yury S. Teterin ◽  
Oleg D. Olisov ◽  
Petr A. Yartsev ◽  
Murad S. Novruzbekov ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Endoscopic Treatment ◽  
Biliary Complications ◽  
Long Term Results ◽  
Biliary Strictures ◽  
Anastomotic Strictures ◽  
Invasive Method ◽  
Nasobiliary Drainage

Aim:to improve the results of treating patients with anastomotic biliary strictures of the bile ducts after orthotopic liver transplantation.Materials and methods.This study is based on the results of the endoscopic treatment of 36 patients with biliary complications after orthotopic liver transplantation, who were admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine from December 2001 to December 2017. The endoscopic treatment program included diagnostic ERCP, endoscopic papillosphincterotomy (EPST), bilioduodenal stenting, nasobiliary drainage, balloon dilatation.Results.Against the background of the staged endoscopic treatment, the stable remission of anastomotic biliary strictures (ABS) was achieved in 17 (53.1 %) patients, with 4 of them (12.5 %) showing a successfully resolved insufficiency of biliobiliary anastomosis (BBA). The average duration of endoscopic treatment was 12 ± 1.9 months. The number of ERCPs performed for each patient varied from 1 to 12 and averaged 3. In the majority of patients (75 %) who received one or more courses of endoscopic treatment, a successful correction of anastomotic strictures with no recurrence within 2–5 years was achieved.Conclusion.Staged endoscopic treatment is established to be highly effective in patients with anastomotic biliary strictures and the insufficiency of bilobiliary anastomoses occurred after orthotopic liver transplantation. Such a treatment allows good long-term results to be achieved by a minimally invasive method.

scholarly journals Treatment of biliodigestive anastomotic strictures after transplantation of left lateral segment of the liver

2020 ◽  
Vol 22 (3) ◽  
pp. 18-25
Author(s):  
A. R. Monakhov ◽  
B. L. Mironkov ◽  
M. A. Voskanov ◽  
S. V. Meshcheryakov ◽  
E. T. Azoev ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Guide Wire ◽  
Biliary Complications ◽  
Biliary Strictures ◽  
Invasive Approach ◽  
Lateral Segment ◽  
Anastomotic Strictures ◽  
Left Lateral Segment ◽  
External Biliary Drainage

Many studies have shown that biliary complications after transplantation of the left lateral segment (LLS) of the liver reduce graft and recipient survival. Thus, timely correction of biliary complications, and strictures in particular, improves long-term outcomes in transplantation. Objective: to analyze our own experience in correcting biliary strictures in LLS graft transplantation. Materials and methods. From February 2014 to April 2020, 425 LLS grafts were transplanted in children. 19 (4.5%) patients were diagnosed with biliary strictures at different times after transplantation (from 0.2 to 97 months). Results. Biliary strictures were more often formed a year after transplantation (17.8 ± 23.9 months). In 14 out of the 19 patients, internal-external biliary drainage was successfully performed with phased replacement of the catheter with one that was larger in diameter (from 8.5 Fr to 14 Fr). The catheters were removed in 8 patients after completion of the treatment cycle. Restenosis was not observed during follow-up (13 ± 8.7 months) after the internal-external biliary drainage catheter had been removed. In 5 cases, antegrade passage of a guide wire through the stricture was unsuccessful. As a result, biliary reconstruction was performed in 4 (21.1%) patients and retransplantation was required in 1 (5.3%) patient. Conclusion. An antegrade minimally invasive approach can successfully eliminate biliary strictures in most children after liver LLS graft transplantation. The proposed technique is effective and safe.

Early biliary complications after pancreatoduodenectomy

2021 ◽  
Vol 26 (4) ◽  
pp. 114-119
Author(s):  
V. Y. Rayn ◽  
D. P. Kislitsin ◽  
A. A. Chernov ◽  
V. V. Bukir
Keyword(s):  
English Language ◽  
Financial Burden ◽  
Bile Leak ◽  
Good Prognosis ◽  
Biliary Complications ◽  
Biliary Strictures ◽  
Exclusion Criteria ◽  
Epidemiological Features ◽  
Wide Range

This study aimed to review latest investigations concerning early biliary complications following major pancreatic surgery. 127 original articles in English language were found via PubMed literature search using key words over the last 5 years. After application of exclusion criteria (full-text in English not available, duplicating paper, age of paper over 5 years) a total of 29 articles were included in this study. Herein we review epidemiology and classification of early biliary complications after pancreatoduodenectomy, current views on pathogenesis, prophylaxis, diagnostics and treatment of early biliary complications. In early postoperative course of pancreatoduodenectomy patients may develop transient jaundice, cholangitis, early biliary strictures and post-procedural bile leak. Frequency of these conditions range from 3 to 24% and depends on epidemiological features of population, statistics and combined conditions. A number of patient- and surgery-dependent risk factors have been described. Modern interventional radiology offers a wide range of procedures for diagnostics and treatment of early biliary complications after pancreatoduodenectomy which showed to be safe and effective when endoscopic manipulations are contraindicated due to high risk. Well-timed diagnosis and treatment allow to avoid severe early biliary complications, re-interventions and reoperations which provides a good prognosis and lowers medical and financial burden.

Connecting Crop Nutrient Use Efficiency to Future Soil Productivity

2018 ◽  
Vol 102 (4) ◽  
pp. 8-10
Author(s):  
Fernando García ◽  
Andrés Grasso ◽  
María González Sanjuan ◽  
Adrián Correndo ◽  
Fernando Salvagiotti
Keyword(s):  
Nutrient Management ◽  
Nutrient Use Efficiency ◽  
Management Strategies ◽  
Crop Productivity ◽  
Soil Productivity ◽  
Nutrient Use ◽  
Grain Crop ◽  
Wide Scale ◽  
Use Efficiency

Trends over the past 25 years indicate that Argentina’s growth in its grain crop productivity has largely been supported by the depletion of the extensive fertility of its Pampean soils. Long-term research provides insight into sustainable nutrient management strategies ready for wide-scale adoption.

Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

2020 ◽  
Vol 132 (6) ◽  
pp. 1675-1682 ◽  
Author(s):  
Jin Wook Kim ◽  
Hee-Won Jung ◽  
Yong Hwy Kim ◽  
Chul-Kee Park ◽  
Hyun-Tai Chung ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Management Strategies ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Years Of Experience ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

Investigation of a New Approach to Predict Water Quality Extremes with a Case Study of Chemical Determinands in Stream Water

1991 ◽  
Vol 24 (6) ◽  
pp. 25-33
Author(s):  
A. J. Jakeman ◽  
P. G. Whitehead ◽  
A. Robson ◽  
J. A. Taylor ◽  
J. Bai
Keyword(s):  
Water Quality ◽  
Stream Water ◽  
Probability Distributions ◽  
Management Strategies ◽  
Hybrid Modelling ◽  
Trend Model ◽  
Environmental Extremes ◽  
Modelling Approach

The paper illustrates analysis of the assumptions of the statistical component of a hybrid modelling approach for predicting environmental extremes. This shows how to assess the applicability of the approach to water quality problems. The analysis involves data on stream acidity from the Birkenes catchment in Norway. The modelling approach is hybrid in that it uses: (1) a deterministic or process-based description to simulate (non-stationary) long term trend values of environmental variables, and (2) probability distributions which are superimposed on the trend values to characterise the frequency of shorter term concentrations. This permits assessment of management strategies and of sensitivity to climate variables by adjusting the values of major forcing variables in the trend model. Knowledge of the variability about the trend is provided by: (a) identification of an appropriate parametric form of the probability density function (pdf) of the environmental attribute (e.g. stream acidity variables) whose extremes are of interest, and (b) estimation of pdf parameters using the output of the trend model.

scholarly journals Contributions to Management Strategies in the NE Atlantic Regarding the Life History and Population Structure of a Key Deep-Sea Fish (Mora moro)

Biology ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 522
Author(s):  
Régis Santos ◽  
Wendell Medeiros-Leal ◽  
Osman Crespo ◽  
Ana Novoa-Pabon ◽  
Mário Pinho
Keyword(s):  
Population Structure ◽  
Life History ◽  
Deep Sea ◽  
Management Strategies ◽  
Size Composition ◽  
Large Size ◽  
The Common ◽  
Fishing Impacts ◽  
Sea Fish

With the commercial fishery expansion to deeper waters, some vulnerable deep-sea species have been increasingly captured. To reduce the fishing impacts on these species, exploitation and management must be based on detailed and precise information about their biology. The common mora Mora moro has become the main deep-sea species caught by longliners in the Northeast Atlantic at depths between 600 and 1200 m. In the Azores, landings have more than doubled from the early 2000s to recent years. Despite its growing importance, its life history and population structure are poorly understood, and the current stock status has not been assessed. To better determine its distribution, biology, and long-term changes in abundance and size composition, this study analyzed a fishery-dependent and survey time series from the Azores. M. moro was found on mud and rock bottoms at depths below 300 m. A larger–deeper trend was observed, and females were larger and more abundant than males. The reproductive season took place from August to February. Abundance indices and mean sizes in the catch were marked by changes in fishing fleet operational behavior. M. moro is considered vulnerable to overfishing because it exhibits a long life span, a large size, slow growth, and a low natural mortality.

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

Open Heart ◽  
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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