Laparoscopic assisted pancreaticoduodenectomy vs. totally laparoscopic pancreaticoduodenectomy for malignant tumor: a retrospectively controlled study

2020 ◽  
Author(s):  
Guo-Liang Yao ◽  
Jing-Ming Zhai
Keyword(s):  
Malignant Tumor ◽  
Statistical Difference ◽  
Operation Time ◽  
Visual Analogue Score ◽  
Controlled Study ◽  
Open Approach ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Biliary Leakage ◽  
Laparoscopic Assisted ◽  
Totally Laparoscopic

Abstract Background Laparoscopic pancreaticoduodenectomy was now accepted worldwide with potential advantages over open pacreaticoduodenectomy. The defect was time wasting with the prone of increased postoperative complications. To assess the potential superiority and feasibility of laparoscopic assisted pancreaticoduodenectomy (LAPD) comparing to totally laparoscopic pancreaticoduodenectomy (TLPD), we introduce this study.Methods Retrospectively analyzed the relation data from the patients who had laparoscopic pancreaticodedunostomy due to malignant tumor in The First Affiliated Hospital of Henan University of Science and Technology during January 2015 to July 2019. Complications and operation time were compared. SPSS 16.0 was employed for analysis.Results Both groups had almost the same baseline characteristics, such as Sex (P=0.880), Age (P=0.861), ASA (P=0.559), BMI (P=0.854), pancreatic duct size (P=0.623), pancreatic texture (P=0.573) and tumor origin (P=0.878). LAPD was association to shorter operation time (231.6±43.7 min VS. 305.4±55.3 min; P=0.047), pancreaticojejunostomy time (13.8±4.2 min VS. 41.6±9.4 min; P=0.007), gastrojejunostomy time (10.9±3.0 min VS. 24.8±6.5 min; P=0.014) and jejunojejunostomy time (7.8±2.4 min VS. 23.4±5.8 min; P=0.005). No statistical difference was observed relation to resection time (P=0.864), cholangiojejunostomy time (P=0.897), blood loss (P=0.723), number of required transfusion (P=0.809), and incision length (P=0.183). Both groups had comparable conversion to open approach (P=0.402). LAPD had comparable complications to TLPD, such as pancreatic leakage (P=0.328), biliary leakage (P=0.673), bleeding (P=0.889), pneumonia (P=0.809) and thrombosis (P=0.443) and incision infection (P=0.889). No statistical difference was observed relation to visual analogue score at 1 day postoperatively (P=0.913) and hospitalization (P=0.137).Conclusions Laparoscopic assisted pancreaticoduodenectomy with open pancreaticojejunostomy should be a choice for certain surgeons with less operation time.

scholarly journals Laparoscopic-assisted reversal of Hartmann's procedure

2010 ◽  
Vol 57 (3) ◽  
pp. 59-65 ◽  
Author(s):  
S. Achkasov ◽  
G. Vorobiev ◽  
A. Zhuchenko ◽  
M. Rinchinov
Keyword(s):  
Wound Infection ◽  
Operation Time ◽  
Main Group ◽  
Hartmann’S Procedure ◽  
Control Group ◽  
Open Approach ◽  
Hartmann's Procedure ◽  
Comparable Control ◽  
Hospital Stays ◽  
Laparoscopic Assisted

BACKGROUND: Postoperative morbidity after reversal of Hartmann's procedure remains high. AIM: to evaluate efficacy of laparoscopic-assisted approach. PATIENTS AND METHODS: 36 patients (19 men, aged 55.71+1.5 years) underwent laparoscopic-assisted reversal procedures in May 2008 - June 2010. The comparable control group consisted of 35 patients (16 men, aged 51.5+13.9 years). RESULTS: operation time was 179.5+65.1 min, 266.9+71.8 min in controls. Blood loss was 64.7+33.7 ml, 181.8+120.4 ml in controls. No conversions occurred in the main group. In three patients of the main group preventive ileostomy was performed. There were 11 diverting stomas in the control group. Postoperative hospital stays were 9.1+2.7 days (12.9+3.4 days in controls). There were 2 (5.9%) postoperative complications in the main group: one wound infection and one parastomal fistula. No mortality occurred. In the control group 3 (9.1%) complications (wound infection and haematoma) were detected. CONCLUSION: laparoscopic-assisted reversal of Hartmann's procedure promotes faster rehabilitation, its results are not worse than after open approach.

scholarly journals Invaginated Duct to Mucosa Pancreaticojejunostomy Reduced Postoperative Pancreatic Leakage: A Matched Case-controlled Study

2020 ◽  
Author(s):  
Guo-Liang Yao ◽  
Meng-Jiao An ◽  
Yong-Gang Fan
Keyword(s):  
Pancreatic Duct ◽  
Statistical Significance ◽  
Operation Time ◽  
Controlled Study ◽  
Biliary Leakage ◽  
Related Data ◽  
Pancreatic Leakage ◽  
Pancreatic Texture ◽  
The Difference ◽  
Group Sex

Abstract Background Postoperative pancreatic leakage was also the obstacle of pancreaticoduodenectomy (PD) which always followed the failure of pancreaticojejunostomy. Dozens of pancreaticojejunostomy had been reported. None showed superiority over others. To assess the potential advantages of invaginated duct to mucosa pancreaticojejunostomy (invaginated D-M PJ), we introduced this study.Methods Retrospectively analyzed the related data from the patients who had their pancreaticodedunostomy due to malignant tumor in The First Affiliated Hospital to Henan University of Science and Technology during January 2017 to August 2019. According to the different procedure of pancreaticojejunostomy, the patients divided into custom D-M group and invaginated D-M group. Sex, age, pancreatic duct size and pancreatic texture were matched. Pancreatic leakage and other complications were compared. SPSS 16.0 was employed for analysis.Results 48 pairs of patients were involved. Both groups had almost the same baseline characterisitics, such as Sex (P=1.000), Age (P=0.897), ASA (P=0.575), BMI (P=0.873), pancreatic duct size (P=0.932), pancreatic texture (P=1.000) and tumor origin (P=0.686). No statistical difference was observed relation to operation outcomes, such as operation time (P=0.632), pancreaticojejunostomy time (P=0.748), blood loss (P=0.617) and number of required transfusion (P=0.523). Pancreatic leakage was significantly declined for invaginated D-M group (P=0.005). The difference of other complications, such as, bleeding (P=0.617), biliary leakage (P=0.646), pneumonia (P=0.594) and thrombosis (P=0.714), didn’t reach statistical significance. Postoperative hospitalization was almost the same for both groups (P=0.764).Conclusions Invaginated D-M PJ could reduce pancreatic leakage followed PD. Invaginated D-M PJ should be a choice for the patients who had PD.

scholarly journals Invaginated Duct to Mucosa Pancreaticojejunostomy Reduced Pstoperative Pancreatic Leakage: A Matched Case-Controlled Study

2020 ◽  
Author(s):  
Guo-Liang Yao ◽  
Meng-Jiao AN ◽  
YongGang Fan
Keyword(s):  
Pancreatic Duct ◽  
Statistical Significance ◽  
Operation Time ◽  
Controlled Study ◽  
Biliary Leakage ◽  
Related Data ◽  
Pancreatic Leakage ◽  
Pancreatic Texture ◽  
The Difference ◽  
Group Sex

Abstract Background Postoperative pancreatic leakage was also the obstacle of pancreaticoduodenectomy (PD) which always followed the failure of pancreaticojejunostomy. Dozens of pancreaticojejunostomy had been reported. None showed superiority over others. To assess the potential advantages of invaginated duct to mucosa pancreaticojejunostomy (invaginated D-M PJ), we introduced this study.Methods Retrospectively analyzed the related data from the patients who had their pancreaticodedunostomy due to malignant tumor in The First Affiliated Hospital to Henan University of Science and Technology during January 2017 to August 2019. According to the different procedure of pancreaticojejunostomy, the patients divided into custom D-M group and invaginated D-M group. Sex, age, pancreatic duct size and pancreatic texture were matched. Pancreatic leakage and other complications were compared. SPSS 16.0 was employed for analysis.Results 48 pairs of patients were involved. Both groups had almost the same baseline characterisitics, such as Sex (P=1.000), Age (P=0.897), ASA (P=0.575), BMI (P=0.873), pancreatic duct size (P=0.932), pancreatic texture (P=1.000) and tumor origin (P=0.686). No statistical difference was observed relation to operation outcomes, such as operation time (P=0.632), pancreaticojejunostomy time (P=0.748), blood loss (P=0.617) and number of required transfusion (P=0.523). Pancreatic leakage was significantly declined for invaginated D-M group (P=0.005). The difference of other complications, such as, bleeding (P=0.617), biliary leakage (P=0.646), pneumonia (P=0.594) and thrombosis (P=0.714), didn’t reach statistical significance. Postoperative hospitalization was almost the same for both groups (P=0.764).Conclusions Invaginated D-M PJ could reduce pancreatic leakage followed PD. Invaginated D-M PJ should be a choice for the patients who had PD.

scholarly journals Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
C. G. Ker ◽  
J. S. Chen ◽  
K. K. Kuo ◽  
S. C. Chuang ◽  
S. J. Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Average Length ◽  
Survival Rates ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Open Approach ◽  
Full Diet ◽  
Or Groups ◽  
Significant Difference

In this study, we try to compare the benefit of laparoscopic versus open operative procedures.Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized.Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

scholarly journals Effect of Gum Chewing on Intestinal Functions after Gynecological Operations: A Randomized Controlled Study

2016 ◽  
pp. 1
Author(s):  
Taylan Şenol ◽  
Mesut Polat ◽  
Enis Özkaya ◽  
Gökhan Ünver ◽  
Ateş Karateke
Keyword(s):  
Blood Loss ◽  
Medical Condition ◽  
Operation Time ◽  
Controlled Study ◽  
Bowel Sound ◽  
Intraoperative Blood Loss ◽  
Gum Chewing ◽  
Postoperative Serum ◽  
Intestinal Functions ◽  
Duration Of Operation

<p><strong>OBJECTIVE:</strong> We aimed to assess the efficacy of gum chewing on intestinal functions after gynecological operations.<br /><strong>STUDY DESIGN:</strong> A total of 86 women who underwent gynecological operation with different indications were randomly assigned to 2 groups: Group 1 was assigned to gum chewing after operation (n=52), while Group 2 was directed to routine postoperative care (n=52). Time of first bowel sound and defecation after surgery were recorded to assess the effect of gum chewing. Operation time, blood loss, type of incision, pre and postoperative serum hemoglobin levels were all evaluated.<br /><strong>RESULTS:</strong> There was no difference between groups in terms of age, duration of operation, intraoperative blood loss, pre and postoperative serum hemoglobin levels, duration to first bowel sound, flatulence and defecation (p&gt;0.05). Age (r=0.234, p=0.032), type of incision (r=0.228, p=0.037) were significantly correlated with the time to first bowel sound. Type of incision (r=0.295, p=0.006), duration of operation (r=0.277, p=0.01) and intraoperative blood loss (r=0.298, p=0.006) were significantly correlated with the time to first flatulence. In multivariate regression analyses, none of the variables were found to be significant parameter for time to first bowel sound (p&gt;0.05). <br /><strong>CONCLUSION:</strong> Gum chewing does not affect some of the gastrointestinal functions after gynecological operations and there is no single parameter for time to first bowel sound, first flatulence and first defecation, individual surgical and medical condition differences should be kept in mind while evaluating intestinal functions.</p>

scholarly journals Evaluation of laparoscopic-assisted transanal total mesorectal excision (Ta-TME) for locally advanced distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy

2020 ◽  
Author(s):  
Yingjie Li ◽  
Guoli He ◽  
Lin Wang ◽  
Qiushi Dong ◽  
Xinzhi Liu ◽  
...  
Keyword(s):  
Resection Margin ◽  
Operation Time ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Chemoradiation Therapy ◽  
Pelvic Anatomy ◽  
Mesorectal Excision ◽  
Diverting Ileostomy ◽  
Positive Circumferential Resection Margin ◽  
Laparoscopic Assisted

Abstract Background: To evaluate the use of laparoscopic-assisted transanal and total mesorectal excision (Ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.Methods: Twenty male patients (TA group) with difficult pelvic anatomy (narrow pelvis) who were diagnosed with rectal cancer underwent Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME (LA group) or an open transabdominal TME (OP group) according to age, sex, BMI, distance of tumour from the anal verge, and diameter of the tumour. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. Results: When comparing Ta-TME (TA group), laparoscopic transabdominal TME (LA group), and open transabdominal TME (OP group), the respective mean blood loss (100 mL, 100 mL, 100 mL, p=0.335), postoperative hospital stay (9 days, 9 days, 7 days), number of harvested lymph nodes (7, 6, 7), positive circumferential resection margin rate (0%, 0%, 5%), rate of pathologic complete response (5%,10%,10%), and integrity of TME showed no significant differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time (302 min, 253 min, 135 min), rate of preservation of the anal sphincter (100%, 30%, 45%), and the creation of a protective diverting ileostomy (100%, 30%, 45%, p<0.05 for all).Conclusion: The rate of anal sphincter preservation in the Ta-TME group was considerably greater than that in the other groups, but the safety of the operation did not differ among the 3 groups. Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME.

A Clinical Observational Study on the Application of Enhanced Recovery After Laparoscopic Pancreaticoduodenectomy

2021 ◽  
Author(s):  
Rui Liao ◽  
Ping Che ◽  
Jun-Cai Li ◽  
Jie Chen ◽  
Xiong Yan
Keyword(s):  
Enhanced Recovery ◽  
Operation Time ◽  
Perioperative Period ◽  
Medical Costs ◽  
Time Frame ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
Readmission Rates ◽  
Retrospective Clinical Study ◽  
Previously Treated ◽  
The Impact

Abstract Background: The safety and feasibility of enhanced recovery after surgery (ERAS) for laparoscopic pancreaticoduodenectomy (LPD) are unclear. The aim of this retrospective clinical study was to evaluate the impact of ERAS protocols for LPD.Methods: Between March 2016 and December 2018, a total of 34 consecutive patients with ERAS for LPD were prospectively enrolled and compared with 68 consecutive patients previously treated for non-ERAS after LPD during an equal time frame. The intraoperative and postoperative data were collected and comparatively analyzed. Results: The mean length of postoperative hospital stay (15.8±3.4 and 23.1±5.1 days, P<0.001) and total medical costs (¥14.3±4.8 x104 and ¥15.8±4.9 x104, P=0.017) were reduced significantly in ER group than those in non-ER group. The operation time (462.7±117.0 vs 450.9±109.8 min, P=0.627) and intraoperative blood loss (523.5±270.0 vs 537.5±241.8 mL, P=0.800) were similar in the two groups. The complications of patients with ERAS protocols were not increased (P>0.05). No difference in mortality and readmission rates was found.Conclusions: The ERAS is safe and effective in the perioperative period of LPD. It could effectively reduce the length of postoperative stay and medical costs, and does not increase the incidence of postoperative complications.

scholarly journals P1103A RANDOMIZED CONTROLLED STUDY ON THE DIALYZERS WITH CELLULOSE TRIACETATE MEMBRANE AND WITH POLYSULFONE MEMBRANE FOR MAINTENANCE HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Zhang Chen ◽  
Yang Yun ◽  
Nai-quan Liu ◽  
Guang-yu Zhou ◽  
De-tian Li
Keyword(s):  
Adhesion Molecule ◽  
Statistical Difference ◽  
Cellulose Triacetate ◽  
Intercellular Adhesion Molecule ◽  
Controlled Study ◽  
Maintenance Hemodialysis ◽  
Dialysis Membrane ◽  
Intercellular Adhesion Molecule 1 ◽  
Polysulfone Membrane ◽  
Significant Difference

Abstract Background and Aims With the continuous development and optimization of dialysis membrane materials, polysulfone (PS) as the third generation of dialysis membrane has replaced cellulose triacetate (CTA) and dominated the market because of its better biocompatibility. However, we found that the hypersensitivity to PS could be remitted by the application of CTA in clinical practice. Objective to compare the differences in toxin removal, hematological change and biocompatibility in maintenance hemodialysis (MHD) patients using CTA dialyzer and PS dialyzer. Method A total of 20 MHD patients treated in the Second Blood Purification Center of Shengjing Hospital from June 2017 to September 2017 were enrolled in this study. They were randomly divided into group CTA and group PS (n=10/each group). They were treated with regular hemodialysis of 4 hours/time and 3 times/week for one month. The clearances of creatinine (CR), blood urea nitrogen (BUN) and serum phosphorus (P), the changes of hemoglobin (Hb), platelet (PLT) and white blood cell (WBC), and the differences of C-reactive protein (CRP), IgE, complement 3 (C3), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were compared between group CTA and group PS. Results Age (t=-0.735, P=0.465), gender (c2 =2.410, P=0.120), dialysis age (t=0.336, P=0.738) and primary diseases (c2 =3.817, P=0.701) had no statistical differences between the two groups. Before the hemodialysis with CTA dialyzer and PS dialyzer, there were no statistical differences in all of the parameters between the two groups (P&gt;0.05). After application of CTA dialyzer and PS dialyzer for one month, ①there were no statistical differences in CR, BUN and P, nor in the changes of the above indicators between the two groups (P&gt;0.05); ② there was a statistical difference in Hb change between the two groups (t=-2.282, P=0.027), with better improvement of anemia in group CTA; ③ there was a statistical difference in PLT (t=2.947, P=0.005) between the two groups, with slighter change in group CTA than in group PS (t= 2.219, P=0.031); ④there were no statistical significances in WBC, VCAM-1, ICAM-1, IgE, CRP and C3 between the two groups (P&gt;0.05). Conclusion ①There were no significant difference in the clearances of small molecule toxins between CTA dialyzer and PS dialyzer. ② CTA was better than PS in the improvement of anemia. ③ The effect on PLT was less in group CTA than in group PS. ④ There were no significant differences in biocompatibility between CTA dialyzer and PS dialyzer.

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