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Annals of hepato-biliary-pancreatic surgery最新文献

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Comment on: "Deep learning-based surgical phase recognition in laparoscopic cholecystectomy". 评论"基于深度学习的腹腔镜胆囊切除术手术阶段识别
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-28 Epub Date: 2024-09-19 DOI: 10.14701/ahbps.24-149
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
Improved graft survival by using three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome in liver transplantation. 利用腹腔内三维打印技术提高移植物存活率,防止肝移植中的大尺寸综合征。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-28 Epub Date: 2024-09-26 DOI: 10.14701/ahbps.24-153
Sunghae Park, Gyu-Seong Choi, Jong Man Kim, Sanghoon Lee, Jae-Won Joh, Jinsoo Rhu

Backgrounds/aims: While large-for-size syndrome is uncommon in liver transplantation (LT), it can result in fatal outcome. To prevent such fatality, we manufactured 3D-printed intra-abdominal cavity replicas to provide intuitive understanding of the sizes of the graft and the patient's abdomen in patients with small body size between July 2020 and February 2022.

Methods: Clinical outcomes were compared between patients using our 3D model during LT, and patients who underwent LT without 3D model by using 1 : 5 ratio propensity score-matched analysis.

Results: After matching, a total of 20 patients using 3D-printed abdominal cavity model and 100 patients of the control group were included in this study. There were no significant differences in 30-day postoperative complication (50.0% vs. 64.0%, p = 0.356) and the incidence of large-for-size syndrome (0% vs. 7%, p = 0.599). Overall survival of the 3D-printed group was similar to that of the control group (p = 0.665), but graft survival was significantly superior in the 3D-printed group, compared to the control group (p = 0.034).

Conclusions: Since it showed better graft survival, as well as low cost and short production time, our 3D-printing protocol can be a feasible option for patients with small abdominal cavity to prevent large-for-size syndrome after LT.

背景/目的:虽然大尺寸综合征在肝移植(LT)中并不常见,但它可能导致致命的结果。为了避免这种致命后果,我们在 2020 年 7 月至 2022 年 2 月期间制作了三维打印的腹腔内复制品,以便让体型较小的患者直观地了解移植物和患者腹部的大小:方法:通过1:5比例倾向得分匹配分析,比较在LT期间使用我们的三维模型的患者与未使用三维模型的LT患者的临床结果:结果:经过匹配,本研究共纳入了20名使用三维打印腹腔模型的患者和100名对照组患者。术后 30 天并发症(50.0% 对 64.0%,P = 0.356)和大尺寸综合征发生率(0% 对 7%,P = 0.599)无明显差异。3D打印组的总存活率与对照组相似(p = 0.665),但3D打印组的移植物存活率明显优于对照组(p = 0.034):结论:由于三维打印方案显示出较好的移植物存活率,且成本低、制作时间短,因此对于腹腔较小的患者来说,我们的三维打印方案是一种可行的选择,可预防LT术后的 "大尺寸综合征"。
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引用次数: 0
Feasibility of indocyanine green fluorescence imaging to predict biliary complications in living donor liver transplantation: A pilot study. 吲哚菁绿荧光成像预测活体供肝移植胆道并发症的可行性:一项初步研究。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-28 Epub Date: 2025-01-15 DOI: 10.14701/ahbps.24-196
Jaewon Lee, YoungRok Choi, Nam-Joon Yi, Jae-Yoon Kim, Su Young Hong, Jeong-Moo Lee, Suk Kyun Hong, Kwang-Woong Lee, Kyung-Suk Suh

Backgrounds/aims: Liver transplantation (LT) is now a critical, life-saving treatment for patients with liver cirrhosis or hepatocellular carcinoma. Despite its significant benefits, biliary complications (BCs) continue to be a major cause of postoperative morbidity. This study evaluates the fluorescence intensity (FI) of the common bile duct (CBD) utilizing near-infrared indocyanine green (ICG) imaging, and examines its association with the incidence of BCs within three months post-LT.

Methods: This investigation analyzed data from nine living donor LT (LDLT) recipients who were administered 0.05 mg/kg of ICG prior to bile duct anastomosis. Real-time perfusion of the CBD was recorded for three minutes using an ICG camera, and FI was quantified using Image J (National Institutes of Health). Key parameters assessed included F max, F1/2 max, T1/2 max, and the slope (F max/T max) to evaluate the fluorescence response.

Results: BCs occurred in two out of nine patients. These two patients exhibited the longest T1/2 max values, which were linked with lower slope values, implicating a potential relationship between extended T1/2 max, reduced slope, and the occurrence of postoperative BCs.

Conclusions: The study indicates that ICG fluorescence imaging may serve as an effective tool for assessing bile duct perfusion in LDLT patients. While the data suggest that an extended T1/2 max and lower slope may correlate with an increased risk of BCs, further validation through larger studies is required to confirm the predictive value of ICG fluorescence imaging in this setting.

背景/目的:肝移植(LT)是目前治疗肝硬化或肝细胞癌患者的重要救命疗法。尽管肝移植有很多好处,但胆道并发症(BCs)仍然是术后发病率的主要原因。本研究利用近红外吲哚青绿(ICG)成像评估总胆管(CBD)的荧光强度(FI),并研究其与 LT 术后三个月内胆道并发症发生率的关系:这项调查分析了九名活体LT(LDLT)受者的数据,这些受者在胆管吻合术前注射了0.05 mg/kg的ICG。使用 ICG 相机记录了三分钟的 CBD 实时灌注情况,并使用 Image J(美国国立卫生研究院)对 FI 进行了量化。评估的主要参数包括 F max、F1/2 max、T1/2 max 和斜率(F max/T max),以评估荧光反应:9名患者中有2名出现了BC。这两名患者的最大 T1/2 值最长,而斜率值较低,这表明最大 T1/2 值延长、斜率降低与术后 BCs 的发生之间存在潜在关系:研究表明,ICG 荧光成像可作为评估 LDLT 患者胆管灌注的有效工具。虽然数据表明最大 T1/2 延长和斜率降低可能与 BCs 风险增加相关,但仍需通过更大规模的研究进一步验证 ICG 荧光成像在这种情况下的预测价值。
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引用次数: 0
Propensity score analysis of adjuvant therapy in radically resected gallbladder cancers: A real world experience from a regional cancer center. 根治性切除胆囊癌辅助治疗的倾向评分分析:一家地区癌症中心的实际经验。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-28 Epub Date: 2024-12-30 DOI: 10.14701/ahbps.24-169
Sushma Agrawal, Rahul, Mohammed Naved Alam, Neeraj Rastogi, Ashish Singh, Rajneesh Kumar Singh, Anu Behari, Prabhakar Mishra

Backgrounds/aims: Given the high mortality associated with gallbladder cancer (GBC), the efficacy of adjuvant therapy (AT) remains controversial. We audited our data over an 11-year period to assess the impact of AT.

Methods: This study included all patients who underwent curative resection for GBC from 2007 to 2017. Analyses were conducted of clinicopathological characteristics, surgical details, and postoperative therapeutic records. The benefits of adjuvant chemotherapy (CT) or chemoradiotherapy (CTRT) were evaluated against surgery alone using SPSS version 20 for statistical analysis.

Results: The median age of patients (n = 142) was 50 years. The median overall survival (OS) was 93, 34, and 30 months with CT, CTRT, and surgery alone respectively (p = 0.612). Multivariate analysis indicated that only disease stage and microscopically involved margins significantly impacted OS and disease-free survival (DFS). CT showed increased effectiveness across all prognostic subsets, except for stage 4 and margin-positive resections. Following propensity score matching, median DFS and OS were higher in the CT group than in the CTRT group, although the differences were not statistically significant (p > 0.05).

Conclusions: Radically resected GBC patients appear to benefit more from adjuvant CT, while CTRT should be reserved for cases with high-risk features.

背景/目的:鉴于胆囊癌(GBC)的高死亡率,辅助治疗(AT)的疗效仍存在争议。我们对 11 年间的数据进行了审核,以评估辅助治疗的影响:本研究纳入了 2007 年至 2017 年期间所有接受治愈性切除术的 GBC 患者。对临床病理特征、手术细节和术后治疗记录进行了分析。使用SPSS 20版进行统计分析,评估辅助化疗(CT)或化放疗(CTRT)与单纯手术治疗的优势:患者的中位年龄(n = 142)为 50 岁。CT、CTRT 和单纯手术的中位总生存期(OS)分别为 93、34 和 30 个月(P = 0.612)。多变量分析表明,只有疾病分期和显微受累边缘对OS和无病生存期(DFS)有显著影响。除 4 期和边缘阳性切除术外,CT 在所有预后亚组中都显示出更高的有效性。倾向评分匹配后,CT组的中位DFS和OS均高于CTRT组,但差异无统计学意义(P > 0.05):结论:根治性切除的 GBC 患者似乎从 CT 辅助治疗中获益更多,而 CTRT 应保留给具有高风险特征的病例。
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引用次数: 0
ArtiSential® laparoscopic cholecystectomy versus singlefulcrum laparoscopic cholecystectomy: Which minimally invasive surgery is better? ArtiSential® 腹腔镜胆囊切除术与单全腔腹腔镜胆囊切除术:哪种微创手术更好?
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-28 Epub Date: 2024-09-24 DOI: 10.14701/ahbps.24-137
Jae Hwan Jeong, Seung Soo Hong, Munseok Choi, Seoung Yoon Rho, Pejman Radkani, Brian Kim Poh Goh, Yuichi Nagakawa, Minoru Tanabe, Daisuke Asano, Chang Moo Kang

Backgrounds/aims: In recent years, many minimally invasive techniques have been introduced to reduce the number of ports in laparoscopic cholecystectomy (LC), offering benefits such as reduced postoperative pain and improved cosmetic outcomes. ArtiSential® is a new multi-degree-of-freedom articulating laparoscopic instrument that incorporates the ergonomic features of robotic surgery, potentially overcoming the spatial limitations of laparoscopic surgery. ArtiSential® LC can be performed using only two ports. This study aims to compare the surgical outcomes of ArtiSential® LC with those of single-fulcrum LC.

Methods: This retrospective study compared ArtiSential® LC and single-fulcrum LC among LCs performed for gallbladder (GB) stones at the same center, analyzing the basic characteristics of patients; intraoperative outcomes, such as operative time, estimated blood loss, and intraoperative GB rupture; and postoperative outcomes, such as length of hospital stay, incidence of postoperative complications, and postoperative pain.

Results: A total of 88 and 63 patients underwent ArtiSential® LC and single-fulcrum LC for GB stones, respectively. Analysis showed that ArtiSential® LC resulted in significantly fewer cases of surgeries longer than 60 minutes (30 vs. 35 min, p = 0.009) and intraoperative GB ruptures (2 vs. 10, p = 0.007). In terms of postoperative outcomes, ArtiSential® LC showed better results in the respective visual analog scale (VAS) scores immediately after surgery (2.59 vs. 3.73, p < 0.001), and before discharge (1.44 vs. 2.02, p = 0.01).

Conclusions: ArtiSential® LC showed better results in terms of surgical outcomes, especially postoperative pain. Thus, ArtiSential® LC is considered the better option for patients, compared to single-fulcrum LC.

背景/目的:近年来,许多微创技术被引入到腹腔镜胆囊切除术(LC)中,以减少孔的数量,从而带来减少术后疼痛和改善美容效果等好处。ArtiSential® 是一种新型多自由度铰接式腹腔镜器械,它结合了机器人手术的人体工程学特点,有可能克服腹腔镜手术的空间限制。ArtiSential®腹腔镜手术只需两个端口即可完成。本研究旨在比较 ArtiSential® LC 与单全腔镜 LC 的手术效果:这项回顾性研究比较了同一中心为胆囊结石患者实施的 ArtiSential® LC 和单全腔LC,分析了患者的基本特征;术中结果,如手术时间、估计失血量、术中胆囊破裂;术后结果,如住院时间、术后并发症发生率、术后疼痛:分别有88名和63名患者接受了ArtiSential® LC和单全腔LC手术治疗胃食管结石。分析表明,ArtiSential® LC 使手术时间超过 60 分钟(30 分钟对 35 分钟,P = 0.009)和术中胃肠道破裂(2 例对 10 例,P = 0.007)的病例明显减少。在术后效果方面,ArtiSential® LC 在术后即刻(2.59 对 3.73,p < 0.001)和出院前(1.44 对 2.02,p = 0.01)的视觉模拟量表(VAS)评分方面显示出更好的效果:ArtiSential®LC在手术效果,尤其是术后疼痛方面显示出更好的效果。结论:ArtiSential® LC 在手术疗效尤其是术后疼痛方面显示出更好的效果,因此,与单全髋关节置换术相比,ArtiSential® LC 被认为是患者更好的选择。
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引用次数: 0
A rare case of a large solid pseudopapillary neoplasm with extensive liver metastasis. 一例罕见的巨大实性假乳头状瘤伴广泛肝转移。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-28 Epub Date: 2024-10-15 DOI: 10.14701/ahbps.24-147
Jun Hyung Kim, Hyung Sun Kim, Jung Min Lee, Ji Hae Nahm, Joon Seong Park

Solid pseudopapillary neoplasms (SPNs) are uncommon pancreatic tumors that primarily affect young females. We report a case of a 24-year-old female diagnosed with SPN and liver metastasis during a routine examination. Imaging revealed an 8-cm pancreatic mass with multiple liver metastases. Histopathology confirmed SPN. Subsequent next-generation sequencing revealed a CTNNB1 mutation. The patient underwent a total pancreatectomy with splenectomy, right hemihepatectomy, and intraoperative radiofrequency ablation. Two years after the surgery, she remained complication-free. She is under regular surveillance. This case underscores the importance of early detection and comprehensive management of SPN.

实体假乳头状瘤(SPN)是一种不常见的胰腺肿瘤,主要影响年轻女性。我们报告了一例 24 岁女性的病例,她在一次常规检查中被诊断为 SPN 和肝转移。影像学检查发现一个 8 厘米大的胰腺肿块,并伴有多处肝转移。组织病理学证实为 SPN。随后的新一代测序发现了 CTNNB1 突变。患者接受了全胰腺切除术、脾切除术、右半肝切除术和术中射频消融术。术后两年,她一直没有出现并发症。目前她仍在接受定期监测。该病例强调了早期发现和综合治疗 SPN 的重要性。
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引用次数: 0
Feasibility and safety of robotic radical resection for hilar cholangiocarcinoma in highly selected patients: A systematic review and meta-analysis with meta-regression.
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-26 DOI: 10.14701/ahbps.24-236
Shahab Hajibandeh, Shahin Hajibandeh, Thomas Satyadas

To examine the feasibility and safety of robotic radical resection (RRR) for hilar cholangiocarcinoma (HCCA). A PRISMA-compliant meta-analysis with meta-regression was conducted, including studies reporting outcomes of RRR in patients with HCCA. Six studies comprising 295 patients were included. In highly selected patients (body mass index [BMI] < 25 kg/m" ; tumor size < 3 cm), RRR of HCCA proved safe and feasible (Clavien-Dindo ≥ III complications: 14.8% [95% confidence interval 8.7%-20.8%]; 30-day mortality: 1.9% [0%-4.2%]; conversion to open surgery: 1.9% [0%-4.2%]; intraoperative blood loss: 210 mL [119-301 mL]; operative time: 481 minutes [339-623 minutes]; R0 resection rate: 82.2% [75.0%-89.4%]; retrieved lymph nodes: 12 [9-16]). Younger age (p = 0.008), higher BMI (p = 0.009), larger tumors (p = 0.048), and performing liver resections (p = 0.017) increased blood loss. American Society of Anesthesiologists status ≥ III (p < 0.001) and Bismuth IV disease (p < 0.001) increased operative times. Preoperative biliary drainage (p = 0.027) enhanced R0 resection rates. RRR led to less bleeding (mean difference [MD]: -184 mL, p = 0.0005), longer operative times (MD: 162 minutes, p = 0.001), and improved R0 resection rates (odds ratio: 3.29, p = 0.006) compared with the open approach. Subject to selection bias and type 2 error, RRR for HCCA might be safe and feasible in highly selected patients (favorable BMI and tumor size). The findings should not be taken as definitive conclusions but may be used for hypothesis generation in subsequent trials.

{"title":"Feasibility and safety of robotic radical resection for hilar cholangiocarcinoma in highly selected patients: A systematic review and meta-analysis with meta-regression.","authors":"Shahab Hajibandeh, Shahin Hajibandeh, Thomas Satyadas","doi":"10.14701/ahbps.24-236","DOIUrl":"https://doi.org/10.14701/ahbps.24-236","url":null,"abstract":"<p><p>To examine the feasibility and safety of robotic radical resection (RRR) for hilar cholangiocarcinoma (HCCA). A PRISMA-compliant meta-analysis with meta-regression was conducted, including studies reporting outcomes of RRR in patients with HCCA. Six studies comprising 295 patients were included. In highly selected patients (body mass index [BMI] < 25 kg/m\" ; tumor size < 3 cm), RRR of HCCA proved safe and feasible (Clavien-Dindo ≥ III complications: 14.8% [95% confidence interval 8.7%-20.8%]; 30-day mortality: 1.9% [0%-4.2%]; conversion to open surgery: 1.9% [0%-4.2%]; intraoperative blood loss: 210 mL [119-301 mL]; operative time: 481 minutes [339-623 minutes]; R0 resection rate: 82.2% [75.0%-89.4%]; retrieved lymph nodes: 12 [9-16]). Younger age (<i>p</i> = 0.008), higher BMI (<i>p</i> = 0.009), larger tumors (<i>p</i> = 0.048), and performing liver resections (<i>p</i> = 0.017) increased blood loss. American Society of Anesthesiologists status ≥ III (<i>p</i> < 0.001) and Bismuth IV disease (<i>p</i> < 0.001) increased operative times. Preoperative biliary drainage (<i>p</i> = 0.027) enhanced R0 resection rates. RRR led to less bleeding (mean difference [MD]: -184 mL, <i>p</i> = 0.0005), longer operative times (MD: 162 minutes, <i>p</i> = 0.001), and improved R0 resection rates (odds ratio: 3.29, <i>p</i> = 0.006) compared with the open approach. Subject to selection bias and type 2 error, RRR for HCCA might be safe and feasible in highly selected patients (favorable BMI and tumor size). The findings should not be taken as definitive conclusions but may be used for hypothesis generation in subsequent trials.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
From the operating room: Surgeons' views on difficult laparoscopic cholecystectomies.
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-26 DOI: 10.14701/ahbps.24-219
Ritika Agarwal, Vinay M D Prabhu, Nitin A R Rao

Backgrounds/aims: Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons' perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria.

Methods: A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at p < 0.05.

Results: Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons.

Conclusions: This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.

{"title":"From the operating room: Surgeons' views on difficult laparoscopic cholecystectomies.","authors":"Ritika Agarwal, Vinay M D Prabhu, Nitin A R Rao","doi":"10.14701/ahbps.24-219","DOIUrl":"https://doi.org/10.14701/ahbps.24-219","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons' perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons.</p><p><strong>Conclusions: </strong>This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Short-term and long-term outcomes of pancreas preserving total duodenectomy: A case series from a single center with 13 years' experience and complimentary meta-analysis.
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-20 DOI: 10.14701/ahbps.24-214
Mohammed Hammoda, Shahab Hajibandeh, Bilal Al-Sarireh

Backgrounds/aims: To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD).

Methods: A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series. All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis.

Results: A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%-5.2%), CD II complications in 21.1% (14.6%-27.6%), CD III complications in 18.1% (9.3%-26.9%), CD IV complications in 2.7% (0.5%-4.9%), and CD V complications in 2.2% (0.2%-4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy.

Conclusions: PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

{"title":"Short-term and long-term outcomes of pancreas preserving total duodenectomy: A case series from a single center with 13 years' experience and complimentary meta-analysis.","authors":"Mohammed Hammoda, Shahab Hajibandeh, Bilal Al-Sarireh","doi":"10.14701/ahbps.24-214","DOIUrl":"https://doi.org/10.14701/ahbps.24-214","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD).</p><p><strong>Methods: </strong>A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series. All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis.</p><p><strong>Results: </strong>A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%-5.2%), CD II complications in 21.1% (14.6%-27.6%), CD III complications in 18.1% (9.3%-26.9%), CD IV complications in 2.7% (0.5%-4.9%), and CD V complications in 2.2% (0.2%-4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, <i>p</i> = 0.830), total complications (OR: 0.77, <i>p</i> = 0.440), postoperative pancreatic fistula (OR: 0.43, <i>p</i> = 0.140), delayed gastric emptying (OR: 0.70, <i>p</i> = 0.450), or postoperative bleeding (OR: 0.97, <i>p</i> = 0.960) between PPTD and pancreaticoduodenectomy.</p><p><strong>Conclusions: </strong>PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"Liver-loop": a case report of an alternative modified liver hanging maneuver. "肝循环":另一种改良肝脏悬吊术的病例报告。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-18 DOI: 10.14701/ahbps.24-217
Rodrigo Antonio Gasque, José Gabriel Cervantes, Magalí Chahdi Beltrame, Marcelo Enrique Lenz Virreira, Francisco Juan Mattera, Emilio Gastón Quiñonez

The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified "Loop-Hanging" maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis. Our "Loop-Hanging" technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury. Further research is required to assess its safety and broader applicability.

{"title":"\"Liver-loop\": a case report of an alternative modified liver hanging maneuver.","authors":"Rodrigo Antonio Gasque, José Gabriel Cervantes, Magalí Chahdi Beltrame, Marcelo Enrique Lenz Virreira, Francisco Juan Mattera, Emilio Gastón Quiñonez","doi":"10.14701/ahbps.24-217","DOIUrl":"https://doi.org/10.14701/ahbps.24-217","url":null,"abstract":"<p><p>The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified \"Loop-Hanging\" maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis. Our \"Loop-Hanging\" technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury. Further research is required to assess its safety and broader applicability.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Annals of hepato-biliary-pancreatic surgery
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