scholarly journals Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

2021 ◽  
Vol 8 ◽  
Author(s):  
Antonio Giuliani ◽  
Pasquale Avella ◽  
Anna Lucia Segreto ◽  
Maria Lucia Izzo ◽  
Antonio Buondonno ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Postoperative Outcomes ◽  
Cyanoacrylate Glue ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
The Mean

Background: Surgical resection is the only possible choice of treatment in several pancreatic disorders that included periampullar neoplasms. The development of a postoperative pancreatic fistula (POPF) is the main complication. Despite three different surgical strategies that have been proposed–pancreatojejunostomy (PJ), pancreatogastrostomy (PG), and pancreatic duct occlusion (DO)–none of them has been clearly validated to be superior. The aim of this study was to analyse the postoperative outcomes after DO.Methods: We retrospectively reviewed 56 consecutive patients who underwent Whipple's procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit. After pancreatic resection in open surgery, we performed DO of the Wirsung duct with Cyanoacrylate glue independently from the stump characteristics. The mean follow-up was 24.5 months.Results: In total, 29 (60.4%) were men and 19 were (39.6%) women with a mean age of 62.79 (SD ± 10.02) years. Surgical indications were in 95% of cases malignant diseases. The incidence of POPF after DO was 31 (64.5%): 10 (20.8%) patients had a Grade A fistula, 18 (37.5%) Grade B fistula, and 3 (6.2%) Grade C fistula. No statistical differences were demonstrated in the development of POPF according to pancreatic duct diameter groups (p = 0.2145). Nevertheless, the POPF rate was significantly higher in the soft pancreatic group (p = 0.0164). The mean operative time was 358.12 min (SD ± 77.03, range: 221–480 min). Hospital stay was significantly longer in patients who developed POPF (p < 0.001). According to the Clavien-Dindo (CD) classification, seven of 48 (14.58%) patients were classified as CD III–IV. At the last follow-up, 27 of the 31 (87%) patients were alive.Conclusions: Duct occlusion could be proposed as a safe alternative to pancreatic anastomosis especially in low-/medium-volume centers in selected cases at higher risk of clinically relevant POPF.

scholarly journals Pancreatic Duct Occlusion: A Safe and Valid Alternative to Duct Anastomosis After Pancreaticoduodenectomy in a Low Volume Centre

2020 ◽  
Author(s):  
Antonio Giuliani ◽  
Aldo Rocca ◽  
Anna Lucia Segreto ◽  
Marianna Paccone ◽  
Maria Lucia Izzo ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Enzyme ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
Low Volume

Abstract Background: Pancreaticoduodenectomy is the only possible choice of treatment for peri-ampoullar neoplasms. Morbidity in pancreatic surgery is mainly related to the development of a postoperative pancreatic fistula (POPF). According to International Study Group on Pancreatic Fistula it is possible to grade POPF based on clinical variables. Three main different surgical strategies have been proposed to deal with the pancreatic stump following pancreaticoduodenectomy: pancreatojejunostomy, pancreatogastrostomy and pancreatic duct occlusion, but none of them has been clearly demonstrated to be superior to the others. The aim of our study is to evaluate the feasibility of duct occlusion and its correlations with postoperative pancreatic fistula, “brittle diabetes” and overall survival in a low volume centre. We decided to review our previous experience in the light of the recent Covid pandemic where, in our country, it has been forced in many regions to displace treatment of oncological patients in low volume hospitals with limited experienceMethods: We retrospectively reviewed 56 consecutive patients, from a prospective maintained database, who underwent Whipple’s procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit with a low volume of pancreatic resections. The mean follow-up was 24.5 months. Results: The overall incidence of postoperative pancreatic fistula was 66.6%: 15 patients had a Grade A (31.25%), 13 a Grade B fistula (27.03%), and 4 (8.3%) suffered from a life-threatening Grade C fistula. At the last follow-up, 24 of the 28 patients who were alive (85.6%) habitually used substitutive pancreatic enzyme. Conclusion: Duct occlusion can be a safe alternative to pancreatic anastomosis especially in low volume centres and for those patients (age >75 years, obese, hard pancreatic texture, small pancreatic duct) at higher risk of clinically relevant POPF.Trial registration: 'retrospectively registered'

Influence of Pancreatic Duct Occlusion on Islet Hormones in Peripheral and Portal Plasma and in the Pancreas of the Mini-Pig

1985 ◽  
Vol 17 (1) ◽  
pp. 17-24 ◽  
Author(s):  
P.O. Schwille ◽  
W. Engelhardt ◽  
H. Volkholz ◽  
C. Gebhardt ◽  
H. ZimgïbV ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Pancreatic Duct Occlusion ◽  
Islet Hormones ◽  
Duct Occlusion ◽  
Portal Plasma

scholarly journals Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

2021 ◽  
Vol 10 (18) ◽  
pp. 4062
Author(s):  
François-Victor Prigent ◽  
Kévin Guillen ◽  
Pierre-Olivier Comby ◽  
Julie Pellegrinelli ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Volume Reduction ◽  
Renal Angiomyolipoma ◽  
Cyanoacrylate Glue ◽  
Selective Arterial Embolization ◽  
Before And After ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Postembolization Syndrome

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume.

Intestinal Disaccharidase Activity Following Pancreatic Duct Occlusion in the Rat

Pancreas ◽  
1987 ◽  
Vol 2 (3) ◽  
pp. 295-302 ◽  
Author(s):  
M. Hauer-Jensen ◽  
K. Christensen ◽  
H. D. Wilson ◽  
H. P. Schedl
Keyword(s):  
Pancreatic Duct ◽  
Disaccharidase Activity ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion

Role of Cholecystokinin-A (CCK-A) Receptor in Pancreatic Regeneration After Pancreatic Duct Occlusion

Pancreas ◽  
1998 ◽  
Vol 16 (2) ◽  
pp. 114-123 ◽  
Author(s):  
Kyoko Miyasaka ◽  
Minoru Ohta ◽  
Kayoko Tateishi ◽  
Atsuo Jimi ◽  
Akihiro Funakoshi
Keyword(s):  
Pancreatic Duct ◽  
Pancreatic Regeneration ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion

Temporary Pancreatic Duct Occlusion by Ethibloc: Cause of Microcirculatory Shutdown, Acute Inflammation, and Pancreas Necrosis

2001 ◽  
Vol 25 (4) ◽  
pp. 432-437 ◽  
Author(s):  
Thorsten Plusczyk ◽  
Simone Westermann ◽  
Björn Bersal ◽  
Michael Menger ◽  
Gernot Feifel
Keyword(s):  
Pancreatic Duct ◽  
Acute Inflammation ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Pancreas Necrosis

Modified Elmslie–Trillat Procedure for Recurrent Dislocation of the Patella

2016 ◽  
Vol 30 (05) ◽  
pp. 493-500 ◽  
Author(s):  
Genya Mitani ◽  
Takashi Maeda ◽  
Tomonori Takagaki ◽  
Kosuke Hamahashi ◽  
Kenji Serigano ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recurrent Dislocation ◽  
Postoperative Outcomes ◽  
Q Angle ◽  
Tilting Angle ◽  
Kujala Score ◽  
The Mean ◽  
Dislocation Of The Patella

AbstractMany groups have reported good to excellent clinical outcomes of the Elmslie–Trillat (ET) procedure for recurrent dislocation of the patella. However, the mean follow-up period of these studies was no more than 5 years. We hypothesized that the long-term postoperative outcomes of the modified ET procedure for recurrent dislocation of the patella would be acceptable compared with those of other procedures. The long-term postoperative outcomes of patients treated with the modified ET procedure were examined. A total of 31 knees in 27 patients with recurrent dislocation of the patella who underwent a modified ET procedure (without medial capsular plication) were evaluated. The mean follow-up period was 13.0 years. Pre- and postoperative radiographs were examined to determine the Q-angle, tilting angle, lateral shift ratio, sulcus angle, congruence angle, and Insall–Salvati index. Clinical outcomes were evaluated based on the Fulkerson patellofemoral joint evaluation score, Kujala score, and the presence of the apprehension sign. Radiological evaluation revealed significant postoperative improvements in the Q-angle, tilting angle, lateral shift ratio, congruence angle, Kujala score, and Fulkerson score (p < 0.001). Sixty-eight percent of all patients had a “good” or “excellent” Fulkerson score. The apprehension sign continued to be shown for six knees. Progression of osteoarthritic changes was observed in three knees, and one knee was symptomatic. The modified ET procedure provided satisfactory outcomes based on radiological and clinical evaluations. These results show the long-term effectiveness and safety of the modified ET procedure for recurrent patellar dislocation.

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