A replaced common hepatic artery during pancreaticoduodenectomy is a challenging condition. Prevalence in the general population is 1.8%. A 6-type anatomic classification system introduced by Huang ...was adopted. The type II setting with the replaced common hepatic artery running on the ventral side of the pancreas is extraordinarily rare. Preservation of the replaced common hepatic artery during pancreaticoduodenectomy is recommended in all cases where it is possible.
ABSTRACT
Background
Nanofiber wound dressings remain the domain of in vitro studies. The purpose of our study was to verify the benefits of chitosan (CTS) and polylactide (PLA)-based nanofiber wound ...dressings on a porcine model of a naturally contaminated standardized wound and compare them with the conventional dressings, i.e., gauze and Inadine.
Material and Methods
The study group included 32 pigs randomized into four homogeneous groups according to the wound dressing type. Standardized wounds were created on their backs, and wound dressings were regularly changed. We evaluated difficulty of handling individual dressing materials and macroscopic appearance of the wounds. Wound swabs were taken for bacteriological examination. Blood samples were obtained to determine blood count values and serum levels of acute phase proteins (serum amyloid A, C-reactive protein, and haptoglobin). The crucial point of the study was histological analysis. Microscopic evaluation was focused on the defect depth and tissue reactions, including formation of the fibrin exudate with neutrophil granulocytes, the layer of granulation and cellular connective tissue, and the reepithelialization. Statistical analysis was performed by using SPSS software. The analysis was based on the Kruskal–Wallis H test and Mann–Whitney U test followed by Bonferroni correction. Significance was set at P < .05.
Results
Macroscopic examination did not show any difference in wound healing among the groups. However, evaluation of histological findings demonstrated that PLA-based nanofiber dressing accelerated the proliferative (P = .025) and reepithelialization (P < .001) healing phases, while chitosan-based nanofiber dressing potentiated and accelerated the inflammatory phase (P = .006). No statistically significant changes were observed in the blood count or acute inflammatory phase proteins during the trial. Different dynamics were noted in serum amyloid A values in the group treated with PLA-based nanofiber dressing (P = .006).
Conclusion
Based on the microscopic examination, we have documented a positive effect of nanofiber wound dressings on acceleration of individual phases of the healing process. Nanofiber wound dressings have a potential to become in future part of the common wound care practice.
Background
Postoperative pancreatic fistula is one of the most dreaded complications following pancreatic resections with Grade C the most severe. Several possible types of surgical intervention are ...available but to date, none of them have clearly shown superiority. This study aims to compare different surgical approaches.
Methods
A retrospective analysis of patients who underwent revision surgery for postoperative pancreatic fistula between 2008 and 2020 was performed. Three surgical approaches were compared: open drainage; a disconnection of the pancreaticojejunostomy; and salvage total pancreatectomy. The data of nine monitored parameters were collected. Selected parameters were statistically analyzed and compared.
Results
A total of 54 patients were included. Eighteen patients underwent open drainage, 28 had disconnections of the pancreaticojejunostomy and eight had salvage total pancreatectomy. Statistically significant differences were observed in the time of Intensive Care Unit stay, the number of surgical interventions, 90-day mortality, the number of administered blood transfers and treatment costs. Open drainage showed to be superior in each category. The difference in long-term survival also slightly favored simple drainage.
Conclusion
Open drainage procedure showed to be superior to other types of interventions in most of the monitored parameters. Disconnection of the pancreaticojejunostomy and a salvage total pancreatectomy had similar results, which correlated with the surgical burden of these interventions.
Pancreatic tumors and their surgical resection are associated with significant morbidity and mortality, and the biomarkers currently used for these conditions have limited sensitivity and ...specificity. Because calprotectin and calgranulin C serum levels have been demonstrated to be potential biomarkers of certain cancers and complications of major surgery, the levels of both proteins were tested in the current study in patients with benign and malignant pancreatic tumors that were surgically removed. The baseline serum levels and kinetics of calprotectin and calgranulin C during the 7-day postoperative period were evaluated with immunoassays in 98 adult patients who underwent pancreatic surgery. The baseline serum levels of calprotectin and calgranulin C in patients with malignant (n=84) and benign tumors (n=14) were significantly higher (p<0.01) when compared to those in the healthy controls (n=26). The serum levels of both proteins were also significantly (p<0.05) higher in patients with benign tumors than in those with malignant tumors. After surgery, the serum levels of calprotectin and calgranulin C were significantly (p<0.01) higher than their baseline values, and this elevation persisted throughout the seven days of the follow-up period. Interestingly, starting on day 1 of the postoperative period, the serum levels of both proteins were significantly (p<0.05) higher in the 37 patients who developed postoperative pancreatic fistulas (POPFs) than in the patients who had uneventful recoveries (n=61). Moreover, the serum levels of calprotectin and calgranulin C demonstrated a significant predictive value for the development of POPF; the predictive values of these two proteins were better than those of the serum level of C-reactive protein and the white blood cell count. Taken together, the results of this study suggest that calprotectin and calgranulin C serum levels are potential biomarkers for pancreatic tumors, surgical injury to the pancreatic tissue and the development of POPFs.
The combination of a gastric duplication cyst and duplicated part of the pancreas is an extremely rare developmental defect. The incidence in the population, or the clinical impact thereof, has not ...been uncovered. Symptoms are unspecific. Surgery is the treatment of choice. Timely diagnostics are of utmost importance, albeit they might be challenging at times. Being so rare, case reports are currently the only relevant source of information about the condition. Therefore each published finding is of a clinical impact.
Our work describes the case of a 22 year-old patient, who developed idiopathic acute pancreatitis. A computed tomography scan discovered liquid collection between the antrum of the stomach and the head of the pancreas. Initially, the collection was thought to be a pancreatic pseudocyst. Endoscopic ultrasound-guided transgastric drainage showed to have only a temporary therapeutic effect. Magnetic resonance cholangiopancreatography showed an accessory pancreatic lobe with a separate duct system. The accessory pancreatic lobe exited the body of the pancreas and was in contact with the cystic collection. The patient was indicated for surgical resection. Within the surgery, an
resection of the accessory pancreatic lobe was performed with the antrum of the stomach containing the gastric duplication cyst. No complications were observed in the surgery or thereafter. In the five months follow-up period, the patient was completely symptom free. Histopathological findings confirmed the gastric duplication cyst communicating to accessory pancreatic lobe.
This developmental defect is extremely rare. It can cause recurrent acute pancreatitis. Diagnostics are challenging. Surgery is treatment of choice.
Highlights • Alveolar Echinococcosis is a rare but potentially fatal parasitic infection primarily affecting liver. • The diagnosis and treatment can be difficult and clinical misinterpretation as ...malignancy is not rare. • The principal treatment of Alveolar Echinococcosis is surgery accompanied with chemotherapy.
AIM： To compare natural orifice transluminal endoscopic surgery （NOTES） vs standard laparoscopic ovari- ectomy in mini pigs with respect to technical aspects, complications and parameters of systemic ...inflammatory response. METHODS： This was a randomized, experimental,survival study. Ten female mini pigs underwent NOTES transgastric ovariectomy （NOTES group） and ten fe- male mini pigs underwent laparoscopic ovariectomy （LAP group）. A ＂percutaneous endoscopic gastrostomy＂ approach with guidewire and sphincterotome was used for gastrotomy creation. The ovary was resected us- ing standard biopsy forceps and a snare. The access site was closed using a ＂KING＂ closure with a single endoloop and several clips. In the laparoscopic group, a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic de- vices. C-reactive protein （CRP）, white blood count and interleukin （IL）-6 plasma levels were used as indicators of systemic inflammatory response. All animals were euthanized 28 d after surgery. RESULTS： All animals survived without complications. The mean procedure time was 41.3 min ＋ 17.6 min （NOTES group） and 25.7 min ＋ 5.25 min （LAP group, P 〈 0.02）. Postmortem examinations demonstrated that 50% and 70% of animals were free of any complica- tions in the NOTES and LAP groups, respectively. The remaining animals developed minor complications （ad- hesions） in a comparable frequency between the two groups. In the NOTES group, one animal developed a small intramural gastric abscess close to the gastrotomy site. A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups, respectively, was not considered a complica- tion. In both groups CRP levels increased significantly on the 2nd and 7th postoperative days （POD） and re- turned to normal after 28 d. On POD 2, an increase of CRP level was significantly higher in the NOTES group compared to the LAP group. Values of IL-6 did not dif- fer from baseline values in either of the groups post- operatively. Interestingly, the platelet count decreased significantly on POD 2, but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION： Both NOTES and laparoscopic ovariec-tomies had a similar frequency of minor complications. However, the NOTES technique produced an increased systemic inflammatory response on POD 2.
Introduction: The aim of the study was to evaluate quality of life (QoL) in patients with colorectal cancer (CRC) during complex treatment using the European Organization for Research and Treatment ...of Cancer (EORTC) QLQ-C30 and QLQ-CR29 questionnaires and to implement routine QoL assessment into our practice.
Methods: 30 patients diagnosed with CRC at the Department of Surgery, Faculty Hospital Trnava, Slovakia were included in the study between May 2014 and April 2015. QoL was assessed using EORTC QLQ-C30 and QLQ-CR29 questionnaires before surgery and 1 month after surgery. Data are presented as means, and a paired t-test and independent t-test were used for statistical analysis.
Results: A significant correlation between the type of treatment and QoL was identified in the cohort. A trend to lower QoL was observed in patients with completed neoadjuvant chemoradiotherapy (CRT) and after surgery with stoma formation. The QoL was also affected by the age and gender of the patients.
Conclusion: QoL assessment provides important outcomes reflecting the consequences of particular therapeutic modality in patients with CRC. The worse effect of neoadjuvant CRT and stoma formation was shown in our study in comparison to radical resection with adjuvant chemotherapy.
The relationship between two measures of excess body weight, body mass index (BMI) and body size score, and risk of pancreatic cancer was examined among 574 pancreatic cancer cases and 596 ...frequency‐matched controls from the Czech Republic and Slovakia enrolled between 2004 and 2009. Analyses using multivariable logistic regression showed an increased risk of pancreatic cancer associated with elevated quartiles of BMI at ages 20 fourth quartile: odds ratio (OR) = 1.79, 95% confidence interval (CI): 1.23, 2.61 and 40 (fourth quartile: OR = 1.57, 95% CI: 1.09, 2.27) compared to the lowest quartile. Consistent results were observed for body size score at ages 20 (high versus low: OR = 1.66, 95% CI: 1.08, 2.57) and 40 (medium versus low: OR = 1.36, 95% CI: 1.00, 1.86), but no association was found for BMI and body size score at 2 years before the interview. Stronger risk estimates for BMI were observed in males than females, particularly at age 20, but the analysis of body size yielded similar estimates by sex. When considering excess body weight at both ages 20 and 40 jointly, the highest risk estimates were observed among subjects with elevated levels at both time periods in the analysis of BMI (OR = 1.86, 95% CI: 1.32, 2.62) and body size (OR = 1.53, 95% CI: 1.09, 2.13). These findings, based on two different measures, provide strong support for an increased risk of pancreatic cancer associated with excess body weight, possibly strongest during early adulthood.
The most serious complication after pancreatoduodenectomy (PD) is pancreatic fistula (PF) type C, either as a consequence or independently from postoperative pancreatitis (PP). Differentiating ...between these two types of complications is often very difficult, if not impossible. The most significant factor in early diagnosis of PP after PD is an abrupt change in clinical status. In our retrospective study we also observed significantly higher levels of serum concentrations of CRP and AMS comparing to PF without PP. Based on our findings, CT scan is not beneficial in the early diagnosis of PP. Meantime PF type C is indication to operative revision with mostly drainage procedure which is obviously not much technically demanding, there are no definite guidelines on how to proceed in PP. Therefore the surgeon’s experience determines not only whether PP will be diagnosed early enough and will be differentiated from PF without PP, but also whether a completion pancreatectomy will be performed in indicated cases.
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