Hpb最新文献

Background: Surgical coaching is valuable for disseminating knowledge, refining skills, and fostering continuous professional development for surgeons in practice. This work aims to implement a national coaching program for Canadian HPB surgeons, emphasizing advanced laparoscopic techniques, and to assess subsequent adoption. Secondary objectives include evaluating surgeon perceptions, barriers, and experiences.

Methods: Mid-to-late career HPB surgeons across Canada joined a peer surgical coaching program for advanced laparoscopic skills. The program included didactic sessions followed by practical coaching with case observation, simulation labs, and real-time coaching in the operating room. One lead surgeon from each center was invited to participate in the exit interview.

Results: Eight centers across four provinces completed the program, and one lead surgeon from each site was interviewed. Surgeons reported a 34.9 % increase in self-perceived comfort levels in laparoscopic HPB surgeries, with a 24.2 % and 56.7 % increase in laparoscopic liver and pancreas resections, respectively. Participants acknowledged challenges in implementing surgical coaching, citing barriers related to surgeon and societal factors. Overcoming these challenges required mutual respect, openness to learning, and building sustained change through team collaboration and long-term coach relationships.

Discussion: This work demonstrated the practicality of a nationwide coaching program and its capacity to effect substantial, long-term change in clinical practice.

Background: Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.

Methods: A retrospective single center series including patients with recurrent cholangitis with a non-stenotic HJ after hepato-pancreato-biliary surgery was conducted (2015-2022). Primary outcome was resolution of NSC (i.e. free of NSC during six months). Secondary outcomes included reduction of NSC monthly episode frequency and secondary sclerosing cholangitis.

Results: Overall, 50 of 1179 (4.2%) patients with HJ developed NSC. Treatment included a 'step-up approach' with short-course antibiotics (n = 50, 100 %), prolonged antibiotics (n = 26, 52%), and revisional surgery (n = 7, 14 %). Resolution of NSC was achieved in 15 patients (30%) and reduction of NSC frequency in an additional 21 patients (42%). Concomitant ursodeoxycholic acid use and discontinuation of proton pump inhibitors was the only predictor for resolution (OR 4.229, p = 0.035). Secondary sclerosing cholangitis occurred in 12 patients (24%) and was associated with the number of NSC episodes (OR 1.2, p = 0.050).

Conclusion: A 'step-up approach' to recurrent NSC after HJ resulted in 30 % resolution and further 42 % reduced frequency of NSC although still a quarter of patients developed secondary sclerosing cholangitis. Future prospective studies should assess whether a protocolized approach could improve outcomes.

Background: Utilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication.

Methods: Data on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database. Generalized linear models were utilized to compare healthcare costs and missed workdays among patients undergoing MIS versus open surgery.

Results: Among 8705 patients, 85.0 % (n = 7399) and 15.0 % (n = 1306) of patients underwent an open or MIS HP procedure, respectively. In the unmatched cohort, patients who underwent MIS were more likely to be female (62.7 % vs. 54.6 %) and were less likely to have a Charlson Comorbidity Index score >2 (34.5 % vs. 49.6 %) (both p < 0.05). After entropy balancing, multivariable analysis demonstrated that MIS was associated with lower 1-year post discharge expenditures (mean difference -$9,739, 95%CI-$12,893, -$6585) and fewer missed workdays at 1-year post-discharge (IRR 0.84, 95%CI 0.81-0.87) (all p < 0.001).

Conclusion: At index hospitalization and 1-year post-discharge, an HP MIS approach was associated with lower healthcare expenditures versus open surgery for hepatic and pancreatic resection, as well as fewer missed workdays.

Background: Pancreatic cancer has dismal prognosis with a 5-year survival of 12 %. Cystic lesions have been identified as premalignant lesions. The challenge is to identify lesions with high risk of malignant progression, to offer patients prophylactic curative pancreatic surgery. Previous studies have identified mucin biomarker panels (MUCPs) as potential discriminators of pre- and malignant pancreatic cystic lesions. The present study assessed whether MUCPs contribute to more accurate identification of patients with high-risk pancreatic lesions and improve selection for surgery.

Methods: This retrospective crossover study included 88 patients referred to endoscopic ultrasound because of unclear pancreatic cystic lesions. Clinical management and surgical decision-making with and without MUCP values were assessed by two expert teams with access to patient medical history, radiology, fine-needle aspirates, cytology, and cystic fluid carcinoembryonic antigen.

Results: The adjunct of MUCPs improved decision-making in 2 of 21 cases with surgical pathology, identifying one cancer that otherwise would have been missed and sparing one patient from unnecessary surgery.

Conclusion: Access to MUCPs in a clinical setting improved correct selection of high-risk pancreatic lesions for surgery in single cases. A higher number of incorrect recommendations for surgery with the adjunct of MUCPs was also noted, which calls for caution.