2 research outputs found
Determination of the Length of Pancreatic Ductotomy by Pancreaticoscopy During Frey’s Procedure for Chronic Pancreatitis
No full textObjective:. To study the impact of pancreaticoscopy during Frey’s procedure for treating chronic pancreatitis (CP).
Background:. Excision of the central part of the head of the pancreas along with longitudinal pancreaticotomy (Frey’s procedure) is widely performed for the treatment of CP. However, there is no reliable method to determine the necessary length of longitudinal pancreaticotomy during surgery for CP.
Methods:. Thirty-five consecutive patients with CP were scheduled for Frey’s procedure with intraoperative pancreaticoscopy. The length of the longitudinal pancreaticotomy was tailored by pancreaticoscopy in the following manner: (1) it did not extend beyond the neck in case of a uniformly dilated main duct with patent branch duct confluences and a clear lumen; (2) in case of an obstructed main duct or branch duct confluence of any cause, the main duct was opened to include the most distal obstruction.
Results:. All patients underwent Frey’s procedure and intraoperative pancreaticoscopy. Based on the pancreaticoscopy findings, pancreaticotomy over the body of the gland was not necessary in 34% of the patients. A short (4–6 cm) ductotomy extension over the pancreatic body was required in 14% of the patients. Full-length pancreaticotomy was required in 52% of the patients. The median operative time was 145 minutes, and the median blood loss was 70 mL. Four patients (11.4%) experienced postoperative complications. There were no 90-day postoperative mortality or hospital readmission rates. At the median follow-up of 19 months, 31 patients (88.5%) had no pain attacks requiring medication.
Conclusions:. Intraoperative pancreaticoscopy helps to determine the length of longitudinal pancreaticotomy and reduce pancreatic trauma during Frey’s procedure for treating CP
30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study
No full textObjective: This study aimed to assess 30-day morbidity and mortality rates following cholecystectomy for benign gallbladder disease and identify the factors associated with complications. Summary background data: Although cholecystectomy is common for benign gallbladder disease, there is a gap in the knowledge of the current practice and variations on a global level. Methods: A prospective, international, observational collaborative cohort study of consecutive patients undergoing cholecystectomy for benign gallbladder disease from participating hospitals in 57 countries between January 1 and June 30, 2022, was performed. Univariate and multivariate logistic regression models were used to identify preoperative and operative variables associated with 30-day postoperative outcomes. Results: Data of 21,706 surgical patients from 57 countries were included in the analysis. A total of 10,821 (49.9%), 4,263 (19.7%), and 6,622 (30.5%) cholecystectomies were performed in the elective, emergency, and delayed settings, respectively. Thirty-day postoperative complications were observed in 1,738 patients (8.0%), including mortality in 83 patients (0.4%). Bile leaks (Strasberg grade A) were reported in 278 (1.3%) patients and severe bile duct injuries (Strasberg grades B-E) were reported in 48 (0.2%) patients. Patient age, ASA physical status class, surgical setting, operative approach and Nassar operative difficulty grade were identified as the five predictors demonstrating the highest relative importance in predicting postoperative complications. Conclusion: This multinational observational collaborative cohort study presents a comprehensive report of the current practices and outcomes of cholecystectomy for benign gallbladder disease. Ongoing global collaborative evaluations and initiatives are needed to promote quality assurance and improvement in cholecystectomy
