1,721,065 research outputs found
Tri-Staple vs Ultrasonic Scalpel in Distal Pancreatectomy (TRUDY). A randomized controlled, multicenter, patient blinded, superiority trial
Full text linkBackground: Several systematic reviews have investigated pancreatic stump management to reduce the postoperative pancreatic fistula (POPF) rate. The study aimed to evaluate if the parenchymal transection using the triple-row reinforced stapler decreases the incidence of POPF compared with ultrasonic transection after distal pancreatectomy (DP). Methods: a bicentric, phase 3, patient-blinded, randomized clinical trial was conducted. All patients submitted to elective DP from July 2018 through July 2020 were screened. Exclusion criteria were an extended resection, gastrointestinal resections or anastomoses, and a pancreatic thickness >17 mm measured at the point of parenchymal transection. The experimental group received the Endo GIA Reinforced Reload with Tri-Staple Technology (TS), while the control group the Harmonic Focus (US). Results:A total of 152 patients undergoing DP met the inclusion criteria and were randomized. Due to a positive transection margin on frozen section analysis requiring further resection, seven patients were excluded post-randomization. Therefore, the final population comprised 72 patients in the TS arm and 73 patients in the US arm. Overall, 23 patients (16%) developed POPF. There were 19 grade B (14%) and 4 grade C fistulas (2%). The incidence of POPF was similar between groups (TS 12% vs. US 19%, p=0.191). Conclusion: the present randomized controlled trial of stapled transection using a PGA-reinforced triple-row stapler versus ultrasonic transection with HARMONIC energy devices in elective DP demonstrated no significant difference in POPF rates
Unmet needs in preoperative biliary stenting for patient candidates for pancreaticoduodenectomy: a viewpoint
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Reply to: Central pancreatectomy for benign or low-grade malignant pancreatic lesions - A single-center retrospective analysis of 116 cases
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Reply to: Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy
No full textWe appreciated the Letter by Li et al. regarding our manuscript on the impact of preoperative biliary drainage (PBD) on postoperative outcomes after pancreaticoduodenectomy (PD). The manuscript reflects the institutional policy of the jaundice treatment of the patients undergoing PD. Our center is a high volume center, treating patients that had often received a PBD in a country-hospital. In this setting, we believe that the bilirubin cutoff described could be the decision driver for the PBD. This article is protected by copyright. All rights reserved
Selective agenesis of pancreatic isthmus parenchyma with preservation of main pancreatic duct continuity, a very rare entity: Case report
No full textAbstractContextAgenesis of the dorsal pancreas is a rare anomaly, mostly associated with other medical conditions. It may be complicated with pancreatic neoplasms.Case reportWe report the case of a 51-year-old male with selective agenesis of pancreatic isthmus with preservation of main pancreatic duct and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with suspicious features of the pancreas.ConclusionThis is probably the first report of isolated agenesis of pancreatic isthmus with conservation of main pancreatic duct
Postoperative infectious complications as potential negative predictors: Analysis of 600 consecutive pancreaticoduodenectomies
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Poor Results of Pancreatoduodenectomy in High-Risk Patients with Endoscopic Stent and Bile Colonization are Associated with E. coli, Diabetes and Advanced Age
Full text linkBackground: Endoscopic stenting has spread as bridge management before pancreatoduedenectomy (PD) to resolve jaundice, but its role is nowadays challenged as it is reported to increase morbidity. Although bile sampling is increasingly performed, its clinical role is unclear. The objective of the study is to assess bile colonization’s impact on outcome. Methods: Results of pancreatoduodenectomy after endoscopic stenting are analyzed in 61 high-risk patients presenting bacterial bile colonization. The impact of 11 demographic, clinical, infectious, and laboratory parameters and outcome, including pancreatic leakage, morbidity, and mortality, is analyzed. Results: All stented patients present bacterial bile colonization and PD mortality approaches 10 %. The presence of E. coli in the bile is significantly related to poor outcome, including 23.5 % mortality (p = 0.034), whereas age (≥70 years) and diabetes present borderline results (p < 0.070 and p < 0.066, respectively). E. coli (p = 0.002) and age (p = 0.017) are also related to grade C pancreatic fistula. Conclusions: In high-risk patients undergoing PD, bile colonization inevitably occurs after endoscopic stenting and is a major risk factor of poor outcome, reaching its maximum in the case of E. coli colonization and elderly patients, where the indication to stent and/or to perform PD should be accurately evaluated. E. coli-targeted antibiotic prophylaxis should be administered
Diurnal and day-to-day biological variation of salivary cortisol and cortisone
Full text linkObjectives: There is a growing interest in the relevance of salivary cortisol and cortisone concentrations in stress-related research. To correctly attribute the magnitude of salivary cortisol and cortisone variation as an effect of a stressful event, a coherent understanding of the day-to-day intra-individual and inter-individual variability across the diurnal cycle of the two steroids is required. However, such information is currently lacking. Methods: This study aimed to overcome these existing limitations by performing an investigation of the biological variation (BV) of salivary cortisol and cortisone within one day and between five days using an LC-MS/MS method. Saliva samples were collected from 20 healthy volunteers immediately after waking up, at 8:00, 12:00, 15:00, 19:00 and 23:00 on each day over five days. All samples were analyzed in duplicate in one run. Nested ANOVA was used to calculate the sums of squares for analytical and biological components of variation. Results: The within-subject BV of salivary cortisol and cortisone (CVI) ranged from a minimum of 29.3 and 19.0 % to a maximum of 56.5 and 49.1 %, respectively, while the between-subject biological variation (CVG) ranged from 29.7 and 29.0 % to 51.6 and 43.6 %. The reference change values (RCVs) ranged from 96 to 245 % for cortisol and from 55 to 194 % for cortisone. A medium index of individuality was observed for both compounds at all time points. Conclusions: This study provides updated BV estimates and RCVs for different times of day that can be used to assess the magnitude of change in biomarkers in future stress-related research
An Antimicrobial Stewardship Program in Pancreatic Surgery Reduces the Infectious Risk of Colonized Bile, Reducing the Predictive Value of the Intraoperative Bile Culture - A Before-after Study on 1638 Pancreatoduodenectomies
No full textObjective: Evaluation of pancreatic surgery-specific antimicrobial stewardship (AMS) program on surgical site infections (SSI), focusing on bile microbiology and colonization. Summary of background data: Colonized bile is well known to increase the risk of SSIs after pancreatoduodenectomy (PD). However, AMS programs seem to reduce their occurrence. Methods: This observational before-after study included patients who underwent PD from 2015 to 2022 at a high-volume pancreatic center (#NCT04199494). Pre-AMS data spanned from January 2015 to November 2019, and post-AMS data from December 2019 to October 2022. Intraoperative bile samples were analyzed for microbiology. The AMS program involved preoperative rectal screening for multidrug-resistant bacteria to guide personalized surgical antibiotic prophylaxis (SAP). Tailored SAP was used for patients colonized with resistant pathogens. SSI rates, length of stay, major and pancreatic surgery-specific complications, and mortality were assessed using standard statistics. Results: Of 1,638 patients included, 1,321 (80.6%) had intraoperative bile sampling, with 909 samples (68.8%) testing positive for colonization. The most common bacteria were Enterobacterales (75%), 18% ESBL-producing, and Enterococci (60%), 4% of which were vancomycin-resistant. Colonized bile was associated with male gender, jaundice, biliary stenting, and positive rectal screening (P<0.05). Before AMS, colonized bile correlated with higher SSI rates (38% vs. 31%, P=0.008). Post-AMS, no significant difference was observed (29% vs. 28%, P=0.5). Tailored SAP reduced overall SSI (34% reduction, P=0.002) and superficial SSI (59% reduction, P=0.011). Conclusions: Pancreatic surgery-specific AMS with tailored SAP reduces SSIs and diminishes the predictive value of colonized bile for SSIs. Intraoperative bile cultures remain valuable for postoperative management
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