Browsing by Subject "Pancreaticoduodenectomy"

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    Sequential drain amylase to guide drain removal following pancreatectomy
    (Elsevier, 2018-06) Villafane-Ferriol, N.; Van Buren, G.; Mendez-Reyes, J.E.; McElhany, A.L.; Massarweh, N.N.; Silberfein, E.; Hsu, C.; Tran Cao, H.S.; Schmidt, C.; Zyromski, N.; Dillhoff, M.; Roch, A.; Oliva, E.; Smith, A.C.; Zhang, Q.; Fisher, W.E.; Surgery, School of Medicine
    BACKGROUND: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. METHODS: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. RESULTS: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. CONCLUSIONS: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.
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    Vascular challenges from pancreatoduodenectomy in the setting of coeliac artery stenosis
    (BMJ Publishing Group, 2017-03-16) Beane, Joal D.; Schwarz, Roderich E.; Surgery, School of Medicine
    Coeliac artery stenosis due to median arcuate ligament compression or atherosclerotic disease is a frequently unrecognised challenge to recovery after pancreatoduodenectomy. The described case illustrates management with intraoperative superior mesenteric artery to hepatic artery bypass graft that led to haemorrhagic challenges postoperatively but ultimately a good recovery. Aspects of preoperative diagnosis, preoperative intervention and intraoperative management options are reviewed. Surgeons need to possess these tools to prevent complications from coeliac artery stenosis when pancreatoduodenectomy is required.