Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration

2020 ◽  
Vol 86 (4) ◽  
pp. 334-340
Author(s):  
Yi Shen ◽  
Binbin Guo ◽  
Laiyong Wang ◽  
Hui Peng ◽  
Jinfang Pan ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Pancreatic Fistula ◽  
Influence Factors ◽  
Fistula Formation ◽  
Physiological Parameter ◽  
Targeted Prevention ◽  
Hepatolenticular Degeneration ◽  
Abdominal Drainage ◽  
Drainage Fluid ◽  
Peritoneal Drainage

Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function ( P = 0.041), pancreatic texture ( P = 0.029), degree of splenomegaly ( P = 0.003), and operative method ( P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.

scholarly journals Bacteriological concentration of peritoneal drainage fluid could make an early diagnosis of anastomotic leakage following rectal resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wei Ge ◽  
Hai-yan Gong ◽  
Yong-quan Xia ◽  
Li-hua Shao ◽  
Han Shen ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Anastomotic Leakage ◽  
Confidence Intervals ◽  
General Surgery ◽  
Ph Value ◽  
Rectal Resection ◽  
Drainage Fluid ◽  
Good Marker ◽  
Peritoneal Drainage ◽  
Auc Value

AbstractTo investigate that the bacteriological concentration and pH value in peritoneal drainage fluid might serve as indicators of early diagnosis of anastomotic leakage following rectal resection. We prospectively analyzed consecutive patients who were treated for rectal diseases with anastomosis at the department of general surgery, the affiliated hospital of Nanjing University Medical School between August 2018 and December 2020. The bacteriological concentration and the pH value in peritoneal drainage fluid were tested on the first, fourth, seventh days postoperatively. A total of 300 consecutive patients underwent rectal resection were tested. 21 patients present with AL and the overall AL rate was 7%. The bacteriological concentration in peritoneal drainage fluid of AL group was significantly higher than that in non-AL group. The AUC value was 0.98 (95% confidence intervals 0.969–1.000) according to the ROC curve. The best cut-off value was 1143/uL. The sensitivity and specificity were 100% and 93.19% respectively. There was no difference of pH value between the AL and non-AL groups. According the results of present study, a high bacteriological concentration in peritoneal drainage fluid is a good marker for predicting and diagnosing AL following rectal resection. However, owing to the limitation of the sample, there was no validation attempt in the study. A large sample study is needed to validate the conclusion.

scholarly journals Bacteriological Concentration of Peritoneal Drainage Fluid Could Make an Early Diagnosis of Anastomotic Leakage Following Rectal Resection

2021 ◽  
Author(s):  
Wei Ge ◽  
Hai-yan Gong ◽  
Yong-quan Xia ◽  
Li-hua Shao ◽  
Han Shen ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Anastomotic Leakage ◽  
Sensitivity And Specificity ◽  
General Surgery ◽  
Ph Value ◽  
Rectal Resection ◽  
Drainage Fluid ◽  
Good Marker ◽  
Peritoneal Drainage ◽  
Auc Value

Abstract Purpose: To investigate that the bacteriological concentration and pH value in peritoneal drainage fluid might serve as indicators of early diagnosis of anastomotic leakage following rectal resection.Methods: We prospectively analyzed consecutive patients who were treated for rectal diseases with anastomotic stoma at the department of general surgery, the affiliated hospital of Nanjing University Medical School between August 2018 and December 2020. The bacteriological concentration and the pH levels in peritoneal drainage fluid were tested on the first, fourth, seventh days postoperatively.Results: A total of 300 consecutive patients underwent rectal resection were tested. 21 patients present with AL and the overall AL rate was 7%. The bacteriological concentration in peritoneal drainage fluid of AL group was significantly higher than that in non-AL group. The AUC value was 0.98 according to the ROC curve. The best cut-off value was 1143/uL and the sensitivity and specificity were 100% and 93.19% respectively. There was no difference of pH value between the AL and non-AL groups. Conclusion: According the results of present study, a high bacteriological concentration in peritoneal drainage fluid is a good marker for predicting and diagnosing AL following rectal resection. The best cut-off value is1143/uL and the sensitivity and specificity are 100% and 93.19% respectively.

scholarly journals Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Runwen Liu ◽  
Yunqiang Cai ◽  
He Cai ◽  
Yajia Lan ◽  
Lingwei Meng ◽  
...  
Keyword(s):  
Prediction Model ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
C Reactive Protein ◽  
Dynamic Prediction ◽  
Albumin Ratio ◽  
Drainage Fluid ◽  
Reactive Protein ◽  
Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

Use of fibrin glue sealant with polyglycolic acid sheets to prevent pancreatic fistula formation after laparoscopic-assisted gastrectomy

Surgery Today ◽  
2012 ◽  
Vol 43 (5) ◽  
pp. 527-533 ◽  
Author(s):  
Yuichiro Hiura ◽  
Shuji Takiguchi ◽  
Kazuyoshi Yamamoto ◽  
Yukinori Kurokawa ◽  
Makoto Yamasaki ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Fistula Formation ◽  
Fibrin Glue Sealant ◽  
Laparoscopic Assisted

scholarly journals Lymphopenia following pancreaticoduodenectomy is associated with pancreatic fistula formation

2021 ◽  
Vol 25 (2) ◽  
pp. 242-250
Author(s):  
Joshua T. Cohen ◽  
Kevin P. Charpentier ◽  
Thomas J. Miner ◽  
William G. Cioffi ◽  
Rachel E. Beard
Keyword(s):  
Pancreatic Fistula ◽  
Fistula Formation

Risk Factors for Pancreatic Fistula after Stapled Gland Transection

2011 ◽  
Vol 77 (8) ◽  
pp. 965-970 ◽  
Author(s):  
Preeti D. Subhedar ◽  
Sameer H. Patel ◽  
Peter J. Kneuertz ◽  
Shishir K. Maithel ◽  
Charles A. Staley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Staple Line ◽  
Univariate Analysis ◽  
Fistula Formation ◽  
Staple Line Reinforcement ◽  
Mesh Reinforcement ◽  
Included Patient ◽  
Pancreatic Transection ◽  
Clinically Significant

The objective of this study was to identify risk factors for pancreatic fistula (PF) after stapled transection in distal pancreatectomy (DP). Patients undergoing DP using a stapler for transection between 2005 and 2009 were identified from a pancreatic resection database. Variables examined included patient and tumor characteristics, staple size, and the use of mesh reinforcement. Univariate and multivariate regression analyses were performed to identify risk factors for postoperative PF. One hundred forty-nine had stapled transection, and of these, 25 (17%) had mesh reinforcement. The overall morbidity and mortality rates were 28 per cent and less than 1 per cent; 34 (23%) were diabetic. The rate of clinically significant PF was 14 per cent. On univariate analysis, diabetes ( P = 0.04), a firm pancreas ( P = 0.03), use of mesh staple line reinforcement ( P = 0.02), use of a 4.1-mm staple cartridge ( P = 0.01), and blood loss greater than 100 mL ( P = 0.01) were associated with higher pancreatic fistula rates. On multivariate analysis, only the presence of diabetes (OR, 4.17; 95% CI, 1.1-15.3; P = 0.03) and the use of a 4.1-mm cartridge (OR, 8.57; 95% CI, 1.2-60.2; P = 0.03) were independently associated with pancreatic fistula formation. Stapled pancreatic transection provides an acceptable PF rate after DP. Diabetes and staple size influence PF rates. In our experience, use of mesh staple line reinforcement did not reduce the incidence of PF after stapled transection.

scholarly journals Intra operative amylase values as a predictor for clinically relevant pancreatic fistula formation

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S603
Author(s):  
S. Kaushik ◽  
N. Nagesh ◽  
B. Vinay ◽  
H. Venugopal ◽  
K. Ashok Kumar
Keyword(s):  
Pancreatic Fistula ◽  
Fistula Formation

scholarly journals Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Hidetake Amemiya ◽  
Naohiro Hosomura ◽  
Mitsuaki Watanabe ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Conventional Group ◽  
Short Term ◽  
Drainage Fluid ◽  
The Third ◽  
Modified Method ◽  
Early Removal ◽  
Soft Pancreas

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD. Methods In total, 123 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n = 67) and a modified group (n = 56). Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p value = 0.002). Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

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