Pub Date : 2024-09-14DOI: 10.1016/j.hpb.2024.09.005
Angelina Koh, Nicholas Bull, Lisa Brown, Benjamin Thomson, Benjamin Paul Timothy Loveday
Patients with obstructive jaundice are conventionally described as hypocoagulable due to vitamin K malabsorption. However, associated underlying malignancy and synthetic liver dysfunction are mediators of hypercoagulability. The actual effect of biliary obstruction on the coagulation profile is not well characterised. This study aimed to define the coagulation status of patients with established biliary obstruction using rotational thromboelastometry (ROTEM).
阻塞性黄疸患者通常被描述为因维生素 K 吸收不良而导致的低凝状态。然而，相关的潜在恶性肿瘤和合成性肝功能障碍是高凝状态的介质。胆道梗阻对凝血功能的实际影响尚不明确。本研究旨在使用旋转血栓弹性测定法（ROTEM）确定已确诊胆道梗阻患者的凝血状态。
{"title":"Prospective cohort study of rotational thromboelastometry in established biliary obstruction: dispelling the myth of auto-anticoagulation","authors":"Angelina Koh, Nicholas Bull, Lisa Brown, Benjamin Thomson, Benjamin Paul Timothy Loveday","doi":"10.1016/j.hpb.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.005","url":null,"abstract":"Patients with obstructive jaundice are conventionally described as hypocoagulable due to vitamin K malabsorption. However, associated underlying malignancy and synthetic liver dysfunction are mediators of hypercoagulability. The actual effect of biliary obstruction on the coagulation profile is not well characterised. This study aimed to define the coagulation status of patients with established biliary obstruction using rotational thromboelastometry (ROTEM).","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"37 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1016/j.hpb.2024.09.007
Michael J. Kirsch, Helen Paglia, Thiago Araujo, Helen Madsen, Salvador R. Franco, Patrick Hosokawa, Mona Hamermesh, Reed Weiss, Ana Gleisner, Richard D. Schulick, Marco Del Chiaro, Camille Stewart
{"title":"Cannabis use and postoperative outcomes in patients undergoing hepatectomy","authors":"Michael J. Kirsch, Helen Paglia, Thiago Araujo, Helen Madsen, Salvador R. Franco, Patrick Hosokawa, Mona Hamermesh, Reed Weiss, Ana Gleisner, Richard D. Schulick, Marco Del Chiaro, Camille Stewart","doi":"10.1016/j.hpb.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.007","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"51 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.1016/j.hpb.2024.09.004
Andrii Khomiak, Sumaya A. Ghaffar, Salvador R. Franco, Ioannis A. Ziogas, Ethan Cumbler, Ana Gleisner, Marco Del Chiaro, Richard D. Schulick, Benedetto Mungo
The study aimed to investigate the impact of lymph node ratio (LNR) on survival in patients with resectable gallbladder adenocarcinoma.
该研究旨在探讨淋巴结比值（LNR）对可切除胆囊腺癌患者生存期的影响。
{"title":"The impact of lymph node ratio on survival in gallbladder cancer: a national cancer database analysis","authors":"Andrii Khomiak, Sumaya A. Ghaffar, Salvador R. Franco, Ioannis A. Ziogas, Ethan Cumbler, Ana Gleisner, Marco Del Chiaro, Richard D. Schulick, Benedetto Mungo","doi":"10.1016/j.hpb.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.004","url":null,"abstract":"The study aimed to investigate the impact of lymph node ratio (LNR) on survival in patients with resectable gallbladder adenocarcinoma.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"100 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.hpb.2024.09.003
Isabella Frigerio, E-AHPBA Mentorship Program Committee, Sternby Eilard, Asmund Fretland, Andrew A. Gumbs, Bas G. Koerkamp, Giovanni Marchegiani, Florian Primavesi, Elena Rangelova, Nikdohkt Rashidian, Sheraz Yaqub, Babs Zunderhuis, Ghadeer Aljohani, Iakovos Amygdalos, Emre Bozkurt, Kim C. Honselmann, Povilas Ignatavicius, Nouredin, Messaoudi, Philip Müller, Martina Nebbia, Lulu Tanno, Yevhenii Trehub, Ajith K. Siriwardena, Bodil Andersson, Ambareen Kausar, Wojciech G. Polak, Roeland F. de Wilde, Kjetil Soreide, Roberto Salvia, Anita Balakrishnan, John Devar, Marc G. Besselink
{"title":"Nurturing the next generation of HPB surgeons: short term results of the pilot E-AHPBA mentorship program","authors":"Isabella Frigerio, E-AHPBA Mentorship Program Committee, Sternby Eilard, Asmund Fretland, Andrew A. Gumbs, Bas G. Koerkamp, Giovanni Marchegiani, Florian Primavesi, Elena Rangelova, Nikdohkt Rashidian, Sheraz Yaqub, Babs Zunderhuis, Ghadeer Aljohani, Iakovos Amygdalos, Emre Bozkurt, Kim C. Honselmann, Povilas Ignatavicius, Nouredin, Messaoudi, Philip Müller, Martina Nebbia, Lulu Tanno, Yevhenii Trehub, Ajith K. Siriwardena, Bodil Andersson, Ambareen Kausar, Wojciech G. Polak, Roeland F. de Wilde, Kjetil Soreide, Roberto Salvia, Anita Balakrishnan, John Devar, Marc G. Besselink","doi":"10.1016/j.hpb.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.003","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"8 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.hpb.2024.09.002
James M. Halle-Smith, Prudence Leung, Lewis Hall, Merve Aksin, Stijn van Laarhoven, James Skipworth, Nikolaos Chatzizacharias, Rachel M. Brown, Keith J. Roberts
Pathological response of pancreatic ductal adenocarcinoma (PDAC) to neoadjuvant chemotherapy (NAT) has been associated with oncological outcomes. The aim of the study was to investigate factors associated with favourable tumour regression in patients undergoing pancreatic resection for PDAC.
{"title":"Factors associated with favourable pathological tumour response after neoadjuvant chemotherapy in patients with pancreatic ductal adenocarcinoma","authors":"James M. Halle-Smith, Prudence Leung, Lewis Hall, Merve Aksin, Stijn van Laarhoven, James Skipworth, Nikolaos Chatzizacharias, Rachel M. Brown, Keith J. Roberts","doi":"10.1016/j.hpb.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.002","url":null,"abstract":"Pathological response of pancreatic ductal adenocarcinoma (PDAC) to neoadjuvant chemotherapy (NAT) has been associated with oncological outcomes. The aim of the study was to investigate factors associated with favourable tumour regression in patients undergoing pancreatic resection for PDAC.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"31 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1016/j.hpb.2024.08.008
Janyssa Charbonneau, Thomas Couture, Alexis Turgeon, Sarah O'Connor, Jean-François Ouellet, Jean-François Berthin Ouellet, Alexandre Brind’Amour
The optimal choice of treatment for early-stage hepatocellular carcinomas (HCC) remains controversial, with recent conflicted guidelines. This systematic review evaluated whether ablation is oncologically non-inferior to surgical resection. We performed a systematic search of the EMBASE, MEDLINE, CENTRAL and Web of Science databases to identify randomized controlled trials comparing tumor ablation and surgical resection for early-stage HCCs. A non-inferiority margin of 5% (RR 0.93) for overall survival (OS) was considered, following a consensus of clinical experts. We identified 5829 citations from which 11 trials (n = 1736) were included. The non-inferiority of tumor ablation was not observed for OS (RR 0.92; 95%CI 0.85–1.00,I = 33%). Recurrence-free survival was reduced with ablation (RR 0.80; 95%CI 0.69–0.93,I = 49%). There was no difference in terms of extra-hepatic recurrence and minor complications. Tumor ablation was associated with decreased overall morbidity (RR 0.43; 95%CI 0.30–0.62,I = 31%) and major complications (RR 0.22; 95%CI 0.07–0.71,I = 66%). Intra-hepatic recurrence was higher with ablation (RR 1.28; 95%CI 1.10–1.48,I = 12%). Certainty of evidence was low to moderate. We did not observe the oncological non-inferiority of tumor ablation when compared to surgical resection. Nevertheless, most analyses were of low quality of evidence, including the overall survival. We cannot exclude that the true effect of tumor ablation is different than the currently observed one.
{"title":"Oncological outcomes of tumor ablation compared to surgical resection in early-stage hepatocellular carcinomas: a systematic review with meta-analysis","authors":"Janyssa Charbonneau, Thomas Couture, Alexis Turgeon, Sarah O'Connor, Jean-François Ouellet, Jean-François Berthin Ouellet, Alexandre Brind’Amour","doi":"10.1016/j.hpb.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.08.008","url":null,"abstract":"The optimal choice of treatment for early-stage hepatocellular carcinomas (HCC) remains controversial, with recent conflicted guidelines. This systematic review evaluated whether ablation is oncologically non-inferior to surgical resection. We performed a systematic search of the EMBASE, MEDLINE, CENTRAL and Web of Science databases to identify randomized controlled trials comparing tumor ablation and surgical resection for early-stage HCCs. A non-inferiority margin of 5% (RR 0.93) for overall survival (OS) was considered, following a consensus of clinical experts. We identified 5829 citations from which 11 trials (n = 1736) were included. The non-inferiority of tumor ablation was not observed for OS (RR 0.92; 95%CI 0.85–1.00,I = 33%). Recurrence-free survival was reduced with ablation (RR 0.80; 95%CI 0.69–0.93,I = 49%). There was no difference in terms of extra-hepatic recurrence and minor complications. Tumor ablation was associated with decreased overall morbidity (RR 0.43; 95%CI 0.30–0.62,I = 31%) and major complications (RR 0.22; 95%CI 0.07–0.71,I = 66%). Intra-hepatic recurrence was higher with ablation (RR 1.28; 95%CI 1.10–1.48,I = 12%). Certainty of evidence was low to moderate. We did not observe the oncological non-inferiority of tumor ablation when compared to surgical resection. Nevertheless, most analyses were of low quality of evidence, including the overall survival. We cannot exclude that the true effect of tumor ablation is different than the currently observed one.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post-pancreatectomy hemorrhage (PPH) is a fatal complication of pancreatoduodenectomy. When complicated by a pancreatic fistula, pancreatic juice contacting the artery may form a pseudoaneurysm and cause arterial bleeding. We used Hem-o-lok® clips to prevent damage to the outer wall of the gastroduodenal artery (GDA). This study evaluated the usefulness of using Hem-o-lok® clips to ligate the GDA stump to prevent PPH. Overall, 468 patients who underwent PD at our hospital were included. Before July 2020, we ligated the GDA stump using the knot-tying method, which involves double ligation using a silk thread. After July 2020, the GDA stump was double clipped using a 10-mm Hem-o-lok® clip to the residual side without tension on the GDA. Propensity score matching was used to compare cases of pancreatic fistulas that underwent clipping vs. knot-tying. Propensity score matching resulted in 37 patients in each group. PPH occurred in 12 (16.4%) and 4 (6.9%) patients in the knot-tying and clipping groups, respectively. PPH from the GDA stump occurred in eight (11.0%) and one (1.7%) patient in the knot tying and clipping groups, respectively (P = 0.044). Hem-o-lok® clips are safe to apply on the GDA stump during pancreatoduodenectomy to prevent PPH.
{"title":"Usefulness of Hem-o-lok® clips to ligate the gastroduodenal artery in pancreatoduodenectomy","authors":"Norio Kubo, Shigemasa Suzuki, Takahiro Seki, Ryosuke Fukushima, Shunsaku Furuke, Naoki Yagi, Takashi Ooki, Ryusuke Aihara, Kenichiro Araki, Yasuo Hosouchi, Ken Shirabe","doi":"10.1016/j.hpb.2024.08.014","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.08.014","url":null,"abstract":"Post-pancreatectomy hemorrhage (PPH) is a fatal complication of pancreatoduodenectomy. When complicated by a pancreatic fistula, pancreatic juice contacting the artery may form a pseudoaneurysm and cause arterial bleeding. We used Hem-o-lok® clips to prevent damage to the outer wall of the gastroduodenal artery (GDA). This study evaluated the usefulness of using Hem-o-lok® clips to ligate the GDA stump to prevent PPH. Overall, 468 patients who underwent PD at our hospital were included. Before July 2020, we ligated the GDA stump using the knot-tying method, which involves double ligation using a silk thread. After July 2020, the GDA stump was double clipped using a 10-mm Hem-o-lok® clip to the residual side without tension on the GDA. Propensity score matching was used to compare cases of pancreatic fistulas that underwent clipping vs. knot-tying. Propensity score matching resulted in 37 patients in each group. PPH occurred in 12 (16.4%) and 4 (6.9%) patients in the knot-tying and clipping groups, respectively. PPH from the GDA stump occurred in eight (11.0%) and one (1.7%) patient in the knot tying and clipping groups, respectively (P = 0.044). Hem-o-lok® clips are safe to apply on the GDA stump during pancreatoduodenectomy to prevent PPH.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"8 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1016/j.hpb.2024.09.001
Alex B. Blair, Kevin C. Soares, Camilla Guerrero, Jeffrey Drebin, William R. Jarnagin, Jin He, Alice C. Wei
Adoption of robotic pancreatoduodenectomy (RPD) is growing, although there are challenges for safe introduction of this technique, including limitations in on-site expert proctoring. We developed and implemented a structured approach for safe introduction of a new RPD program using virtual collaboration. A structured framework for introducing a RPD program was designed; key steps included obtaining additional training, identifying required resources, establishing a dedicated team, and patient safety considerations. Virtual collaboration with a proctor for bidirectional communication was utilized for remote operative guidance. In the initial cohort, perioperative data and postoperative outcomes were extracted from a prospectively maintained database. From August 2020 to December 2023, 68 patients underwent RPD. The median operative time was 407 min with an estimated blood loss of 150 mL. Median length of stay was 8 days. Negative margins were obtained in 90% of resections. Operative time was significantly shorter in the second half of cases compared to the first (380min vs 441min, p < 0.01) and rate of conversion decreased (6% vs 21%). The safe initiation of a structured RPD program is feasible through virtual expert collaboration. With careful consideration and an appropriate environment, excellent perioperative outcomes are achievable even for initial cases.
{"title":"Initiation of a robotic pancreatoduodenectomy program using virtual collaboration","authors":"Alex B. Blair, Kevin C. Soares, Camilla Guerrero, Jeffrey Drebin, William R. Jarnagin, Jin He, Alice C. Wei","doi":"10.1016/j.hpb.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.001","url":null,"abstract":"Adoption of robotic pancreatoduodenectomy (RPD) is growing, although there are challenges for safe introduction of this technique, including limitations in on-site expert proctoring. We developed and implemented a structured approach for safe introduction of a new RPD program using virtual collaboration. A structured framework for introducing a RPD program was designed; key steps included obtaining additional training, identifying required resources, establishing a dedicated team, and patient safety considerations. Virtual collaboration with a proctor for bidirectional communication was utilized for remote operative guidance. In the initial cohort, perioperative data and postoperative outcomes were extracted from a prospectively maintained database. From August 2020 to December 2023, 68 patients underwent RPD. The median operative time was 407 min with an estimated blood loss of 150 mL. Median length of stay was 8 days. Negative margins were obtained in 90% of resections. Operative time was significantly shorter in the second half of cases compared to the first (380min vs 441min, p < 0.01) and rate of conversion decreased (6% vs 21%). The safe initiation of a structured RPD program is feasible through virtual expert collaboration. With careful consideration and an appropriate environment, excellent perioperative outcomes are achievable even for initial cases.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"113 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.hpb.2024.08.009
Nitzan Zohar, Eliyahu Gorgov, Theresa P. Yeo, Harish Lavu, Wilbur Bowne, Charles J. Yeo, Avinoam Nevler
Post-operative incisional hernia (IH) is a common complication following abdominal surgery. Data regarding IH after major pancreatic surgery are limited. We aim to evaluate the long-term risk of IH following major pancreatic resection. A dual-approach study: a large multi-institutional research network (RN) was investigated for IH incidence and risk factors in propensity-score matched survivors after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), was complemented by a patient-reported questionnaire assessing IH incidence administered to a cohort of pancreatic surgery survivors. RN analysis identified 22,113 patients that underwent pancreatic surgery and created 7092 matched PD and DP patient pairs (follow-up > 1 year). 11.0% of PD patients and 8.6% of DP patients developed IH (P < 0.0001). IH rates were higher with open surgery compared with minimally invasive approaches in PD (OR = 1.56, P = 0.03) and DP (OR = 1.94, P = 0.003). BMI>35 was found to correlate with increased IH rates for PD and DP (OR = 1.87, and OR = 1.86, respectively, P < 0.0001 each), as did postoperative intraabdominal infections and anastomotic leaks (OR = 1.53, and OR = 1.59, respectively, P < 0.0001 each). Patient-based survey of 104 patients, revealed that 16 patients (15%) reported post-operative IH during the follow-up period. BMI≥30, SSI and intra-abdominal abscess were associated with increased IH risk (P < 0.05). Improved survival after pancreatic resection has led to an increased prevalence of long-term surgical sequela. In this study, we demonstrate significant rates of IH among long-term survivors and assess potential risk factors.
术后切口疝（IH）是腹部手术后常见的并发症。有关胰腺大手术后切口疝的数据非常有限。我们旨在评估大胰腺切除术后 IH 的长期风险。我们开展了一项双途径研究：在一个大型多机构研究网络（RN）中调查了胰十二指肠切除术（PD）和远端胰切除术（DP）后倾向分数匹配的幸存者的 IH 发生率和风险因素，并对胰腺手术幸存者群组进行了患者报告问卷调查，以评估 IH 发生率。RN分析确定了22113名接受过胰腺手术的患者，并创建了7092对匹配的胰腺切除术和胰腺切除术患者（随访时间大于1年）。11.0%的胰腺癌患者和8.6%的直肠癌患者发生了IH（P 35与胰腺癌和直肠癌的IH发生率增加相关（OR=1.87和OR=1.86，P均<0.0001）），术后腹腔内感染和吻合口漏也与IH发生率增加相关（OR=1.53和OR=1.59，P均<0.0001）。对 104 名患者进行的患者调查显示，16 名患者（15%）在随访期间报告了术后 IH。BMI≥30、SSI和腹腔内脓肿与IH风险增加有关（P＜0.05）。胰腺切除术后生存率的提高导致长期手术后遗症的发生率增加。在这项研究中，我们证明了长期幸存者中 IH 的显著发生率，并评估了潜在的风险因素。
{"title":"Incisional hernia after major pancreatic resection: long term risk assessment from two distinct sources – A large multi-institutional network and a single high-volume center","authors":"Nitzan Zohar, Eliyahu Gorgov, Theresa P. Yeo, Harish Lavu, Wilbur Bowne, Charles J. Yeo, Avinoam Nevler","doi":"10.1016/j.hpb.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.08.009","url":null,"abstract":"Post-operative incisional hernia (IH) is a common complication following abdominal surgery. Data regarding IH after major pancreatic surgery are limited. We aim to evaluate the long-term risk of IH following major pancreatic resection. A dual-approach study: a large multi-institutional research network (RN) was investigated for IH incidence and risk factors in propensity-score matched survivors after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), was complemented by a patient-reported questionnaire assessing IH incidence administered to a cohort of pancreatic surgery survivors. RN analysis identified 22,113 patients that underwent pancreatic surgery and created 7092 matched PD and DP patient pairs (follow-up > 1 year). 11.0% of PD patients and 8.6% of DP patients developed IH (P < 0.0001). IH rates were higher with open surgery compared with minimally invasive approaches in PD (OR = 1.56, P = 0.03) and DP (OR = 1.94, P = 0.003). BMI>35 was found to correlate with increased IH rates for PD and DP (OR = 1.87, and OR = 1.86, respectively, P < 0.0001 each), as did postoperative intraabdominal infections and anastomotic leaks (OR = 1.53, and OR = 1.59, respectively, P < 0.0001 each). Patient-based survey of 104 patients, revealed that 16 patients (15%) reported post-operative IH during the follow-up period. BMI≥30, SSI and intra-abdominal abscess were associated with increased IH risk (P < 0.05). Improved survival after pancreatic resection has led to an increased prevalence of long-term surgical sequela. In this study, we demonstrate significant rates of IH among long-term survivors and assess potential risk factors.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"7 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.hpb.2024.08.013
Anton F. Gijsen, Roelof P.H. de Vries, Harry G.M. Vaassen, Robert H. Geelkerken, Mike S.L. Liem, Daan J. Lips
Postoperative bile leakage (POBL) due to insufficiency of the hepaticojejunostomy (HJ) after pancreatico-duodenectomy (PD) is associated with high morbidity and mortality. The aim of this cohort study was to determine the clinical relevance of ICG in detecting and preventing POBL of the HJ in robotic minimal invasive pancreatic surgery (R-MIPS). All consecutive robot- and ICG-assisted HJ-anastomoses between 2019 and 2022 were included. All anastomoses were created by a single surgeon using the da Vinci X surgical robot. Biliary leakage was objectified with near infrared technology. Only clinically relevant POBL were considered in this study. Sixty patients who underwent a PD between 2019 and 2022 were included. In ten patients, fluorescence imaging revealed an intra-operative hepaticojejunostomy insufficiency (HJI). Five of these patients developed POBL despite revision but preventing POBL in five patients. Detection of HJI with ICG predicted POBL with a sensitivity and specificity of 41.6% and 89.6% respectively. There was a significant higher chance of developing a POBL if the hepatic duct diameter was less than 5 mm (relative risk = 4.68 (p = 0.0345)), or if an intra-operative HJI was detected (relative risk = 3.57 (p = 0.009)). ICG is a simple and useful tool for detecting intra-operative bile leakage. This study shows that bile illumination with ICG in R-MIPS could prevent postoperative bile leakage.
胰腺十二指肠切除术（PD）后因肝空肠吻合术（HJ）不足导致的术后胆汁渗漏（POBL）与高发病率和高死亡率有关。这项队列研究旨在确定 ICG 在机器人微创胰腺手术（R-MIPS）中检测和预防 HJ POBL 的临床意义。研究纳入了2019年至2022年期间所有连续的机器人和ICG辅助HJ吻合术。所有吻合术均由一名外科医生使用达芬奇 X 手术机器人完成。采用近红外技术对胆漏进行客观分析。本研究只考虑与临床相关的 POBL。研究纳入了在2019年至2022年期间接受腹腔镜手术的60名患者。其中 10 例患者的荧光成像显示术中存在肝空肠吻合术不全（HJI）。其中五名患者尽管进行了翻修，但还是出现了POBL，但有五名患者防止了POBL的发生。用 ICG 检测 HJI 预测 POBL 的敏感性和特异性分别为 41.6% 和 89.6%。如果肝管直径小于 5 毫米（相对风险 = 4.68 (p = 0.0345)），或术中检测到 HJI（相对风险 = 3.57 (p = 0.009)），则发生 POBL 的几率明显更高。ICG 是检测术中胆汁渗漏的一种简单而有用的工具。本研究表明，在 R-MIPS 中使用 ICG 进行胆汁照明可预防术后胆漏。
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