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Several studies showed that sarcopenia is associated with an increase of postoperative complications, with worse postoperative results in patients with pancreatic cancer. According to European Working Group on Sarcopenia, it is a ...
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Several studies showed that sarcopenia is associated with an increase of postoperative complications, with worse postoperative results in patients with pancreatic cancer. According to European Working Group on Sarcopenia, it is a "progressive and generalized skeletal muscle loss" characterized by both loss of skeletal muscle mass and strength (Cruz-Jentoft AJ et al., 2019). Aim of our work was to evaluate the effect of sarcopenia on the occurrence of postoperative complications after pancreatic resections in patients with pancreatic and periampullary cancer. We performed a retrospective analysis of treatment of 152 patients who underwent radical pancreatic resections. Sarcopenia was determined by preoperative computed tomography using the Hounsfield Unit Average Calculation (HUAC). In our investigation we measured the psoas area and density (Hounsfield Units) at the level of the third lumbar vertebral body (L3). Sarcopenia was diagnosed in 66 (43.4%) patients. Among patients with sarcopenia complications occurred in 41 (62.1%), mortality was 4 (6.1%). In the group of patients without sarcopenia, complications occurred in 29 (33.7%) of 86 patients, mortality was 2 (2.3%). The level of postoperative complications in patients with sarcopenia was significantly higher (c2 =12.1, p=0.0005). Postoperative mortality in patients with sarcopenia was higher without significant difference (c2 =1.3, p=0.24). Sarcopenia significantly affects the level of postoperative complications and its detection can be used to improve the selection of patients before pancreatic resections in patients with pancreatic cancer.
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Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-E...
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Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role.
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Trotz zunehmender Aufklärung der Pathophysiologie der akuten Pankreatitis ist eine pankreasspezifische Therapie, z. B. eine Hemmung der Proteasen, nicht erfolgreich. Wahrscheinlich greift dieser therapeutische Ansatz zu spät in ...
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Trotz zunehmender Aufklärung der Pathophysiologie der akuten Pankreatitis ist eine pankreasspezifische Therapie, z. B. eine Hemmung der Proteasen, nicht erfolgreich. Wahrscheinlich greift dieser therapeutische Ansatz zu spät in den pathophysiologischen Ablauf ein. Entscheidend ist die Beurteilung des Schweregrades der Erkrankung und ein interdisziplinäres therapeutisches Vorgehen: Schmerztherapie, enterale Ernährung via Ernährungssonde, Behandlung der extrapankreatischen Komplikationen wie Verbrauchskoagulopathie, Ateminsuffizienz und Nierenversagen. Eine Schlüsselstellung liegt in der Bilanzierung der ausgedehnten Flüssigkeitsverluste. Die prophylaktische Antibiotikaapplikation bei Nekrotisierung zur Verhinderung einer Infektion kann erwogen werden. Bei bereits infizierten Nekrosen besteht Operationsindikation. Bei biliärer Pankreatitis erfolgt bei Nachweis von Gallengangssteinen die endoskopische retrograde Cholangiopankreatographie mit Papillotomie und im Intervall die elektive Cholezystektomie.Despite our increasing knowledge in the pathophysiology of acute pancreatitis therapeutic strategies based on this knowledge, such as inhibition of proteases, are not convincing. It is most likely that these strategies are initiated to late after the onset of pancreatitis. It is of utmost importance to clarify the severity of the disease for planning interdisciplinary approaches: therapy of pain, enteral nutrition via a jejunal tube, as well as treatment of extrapancreatic complications, such as respiratory insufficiency, coagulopathy, and renal insufficiency. A key role plays the exact balance of potential high fluid losses. Prophylactic application of antibiotics such as imipenem in cases of necrotizing pancreatitis to prevent infection is widely used. Infected necroses are an indication for surgery. In biliary pancreatitis one has to remove impacted bile duct stones via ERCP and papillotomy followed by elective cholecystectomy.Schlüsselwörter Akute Pankreatits - Nekrotisierende Pankreatitis - Biliäre Pankreatitis - ERCP - KomplikationenKeywords Acute pancreatitis - Necrotizing pancreatitis - Biliary pancreatitis - ERCP - ComplicationsDie Literatur zu diesem Beitrag finden Sie auf den Seiten XX–XX im Beitrag Mössner J, Keim V: Therapie der chronischen Pankreatitis.
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Background and Aim Infected necrotizing pancreatitis is a highly morbid disease managed by minimally invasive surgical (MIS) or endoscopy‐based interventions. This meta‐analysis compared the clinical outcomes of patients treated...
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Background and Aim Infected necrotizing pancreatitis is a highly morbid disease managed by minimally invasive surgical (MIS) or endoscopy‐based interventions. This meta‐analysis compared the clinical outcomes of patients treated using either approach. Methods MEDLINE and EMBASE databases were searched to identify all randomized trials that compared MIS and endoscopy‐based interventions for treatment of infected necrotizing pancreatitis. Main outcome measure was to compare rates of complications or death during 6‐month follow‐up. Results Three studies involving 184 patients met inclusion criteria. While there was no significant difference in mortality (14.5% vs. 16.1%, risk ratio [RR]?=?1.02, P ?=?0.963), new onset multiple organ failure (5.2% vs. 19.7%, RR ?=?0.34, P ?=?0.045), enterocutaneous fistula/perforation (3.6% vs. 17.9%, RR ?=?0.34, P ?=?0.034) and pancreatic fistula (4.2% vs. 38.2%, RR ?=?0.13, P ?<?0.001) were significantly lower for endoscopic interventions compared to MIS . There was no significant difference in intraabdominal bleeding, endocrine or exocrine pancreatic insufficiency between cohorts. Length of hospital stay was significantly shorter for endoscopy (standardized mean difference, ?0.41, P ?=?0.010). Conclusions An endoscopy‐based treatment approach, as compared to minimally invasive surgery, significantly reduces complications in patients with infected necrotizing pancreatitis.
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After acute necrotizing pancreatitis (ANP), a pancreatic fistula may occur from disconnected pancreatic duct syndrome (DPDS) where a segment of the pancreas is no longer in continuity with the main pancreatic duct. To study the ou...
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After acute necrotizing pancreatitis (ANP), a pancreatic fistula may occur from disconnected pancreatic duct syndrome (DPDS) where a segment of the pancreas is no longer in continuity with the main pancreatic duct. To study the outcome of patients treated using Roux-Y pancreatic fistula tract-jejunostomy for DPDS after ANP. Between 2002 and 2011, patients treated for DPDS in the setting of endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopanreatography (MRCP) documented main pancreatic duct disruption with Roux-Y pancreatic fistula tract-jejunostomy. In all, seven patients with DPDS were treated. The median age was 62 years (range 49-78) and five were men. The cause of ANP was gallstones (2), alcohol (1), ERCP (1) and idiopathic (3). Pancreatic necrosectomy was done in six patients. Time from onset of pancreatitis to fistula drainage was 270 days (164-365). Pancreatic fistulae arose from DPDS in the head/neck (4) and body/tail (3). Patients had a median fistula output of 140 ml (100-200) per day before surgery. The median operative time was 142 min (75-367) and estimated blood loss was 150 ml (25 to 500). Patients began an oral diet on post-operative day 4 (3-6) and were hospitalized for a median of 7 days (5-12). The median follow-up was 264 days (29-740). Subsequently, one patient required a distal pancreatectomy. After surgery, three patients required oral hypoglycaemics. No patient developed pancreatic exocrine insufficiency. Internal surgical drainage using Roux-en-Y pancreatic fistula tract-jejunostomy is a safe and definitive treatment for patients with DPDS. ? 2011 International Hepato-Pancreato-Biliary Association.
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Background Specific data are needed regarding the impact of transfusion on operative complications in pancreatectomy. The objectives of this study were to determine risk factors for transfusion and to ev...
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Background Specific data are needed regarding the impact of transfusion on operative complications in pancreatectomy. The objectives of this study were to determine risk factors for transfusion and to evaluate the potential association between transfusion and operative complications in elective pancreatectomy procedures.
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Background: Specific data are needed regarding the impact of transfusion on operative complications in pancreatectomy. The objectives of this study were to determine risk factors for transfusion and to evaluate the potential assoc...
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Background: Specific data are needed regarding the impact of transfusion on operative complications in pancreatectomy. The objectives of this study were to determine risk factors for transfusion and to evaluate the potential association between transfusion and operative complications in elective pancreatectomy procedures. Study Design: We reviewed our institution's pancreatectomy and ACS-NSQIP databases. Multivariate analysis was used to determine clinicopathologic risk factors predictive of transfusion, and then a transfusion propensity score was developed to evaluate the impact of transfusion on post-pancreatectomy complications. Results: Of the 173 patients who were treated from September 2007 to September 2011, 78 patients (45 %) were transfused ≥ 1 unit of blood (median, 3. 0 units; range, 1-55). Risk factors for transfusion included increasing Body Mass Index (BMI), smoking, increasing mortality risk score, preoperative anemia, intraoperative blood loss, and benign pathology. After controlling for these risk factors using a transfusion propensity score, transfusion was an independent predictor of increased complications, infectious complications, and hospital costs. Conclusions: Multiple factors are predictive of transfusion in pancreatectomy, including increasing BMI and smoking. When controlling for transfusion propensity based on these risk factors, RBC transfusion is associated with worse operative outcomes including infectious complications. Development of protocols and strategies to minimize unnecessary transfusion in pancreatectomy are justified.
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This study aimed to determine current practice in the management and outcome of splanchnic vein thrombosis complicating acute pancreatitis (AP). An audit of prospectively collected data for all patients presenting with AP was cond...
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This study aimed to determine current practice in the management and outcome of splanchnic vein thrombosis complicating acute pancreatitis (AP). An audit of prospectively collected data for all patients presenting with AP was conducted. Patients with splanchnic vein thrombosis were grouped according to vessel involvement and whether or not systemic anticoagulation was administered. Of 127 consecutive patients admitted with AP, 20 had splanchnic venous thrombosis; in all cases the thrombosis was associated with a severe attack of AP. Involvement of the splenic vein (SV), portal vein (PV) and superior mesenteric vein (SMV) was observed in 14, 10 and three patients, respectively. Involvement of more than one vessel was observed in six patients (SV and PV in four patients; SMV and SV in one patient; all three veins in one patient). Thromboses were colocalized with collections in 19 patients. Only four patients received systemic anticoagulation. Resolution of thrombosis was observed in six patients over a median of 77 days. No significant differences were observed in recanalization rates following anticoagulation (P= 0.076). No complications associated with systemic anticoagulation occurred. One patient developed liver failure associated with progressive PV thrombosis and one patient died. Splanchnic vein thrombosis is a relatively common observation in severe AP and is associated with pancreatic necrosis and peripancreatic collections. Recanalization is observed in almost a third of patients, irrespective of whether or not they receive systemic anticoagulation. ? 2011 International Hepato-Pancreato-Biliary Association.
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